Endoluminal closure of gastrogastric fistula

Abstract

Gastrogastric fistulas have a reported incidence of 1.3%–12% after gastric bypass for treatment of morbid obesity. The fistula can occur as a result of incomplete division of the stomach or staple line dehiscence, in the setting of a chronic or perforated marginal ulcer, or as a sequela of staple line leak. In the acute setting, patients can present with tachycardia, fevers, and abdominal pain. However, the development of a gastrogastric fistula in a chronic setting is more subtle: Patients may experience weight regain, postprandial abdominal pain with associated marginal ulcers, and esophageal reflux. Management traditionally consists of surgical revision with associated morbidity [ [1] Corcelles R. Jamal M.H. Daigle C.R. Rogula T. Brethauer S.A. Schauer P.R. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015; 11: 1227-1232 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ]. Here we report on a treatment option that consists of endoscopic intervention with complete closure of the fistula with added benefits of same-day surgery, decreased operative time, no incisions, and minimal morbidity [ 2 Kantsevoy S.V. Thuluvath P.J. Successful closure of a chronic refractory gastrocutaneous fistula with a new endoscopic suturing device (with video). Gastrointest Endosc. 2012; 75: 688-690 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar , 3 Kumar N. Thompson C.C. Transoral outlet reduction for therapy of weight regain after gastric bypass: long-term follow-up. Gastrointest Endosc. Epub 2015 sep 5; Google Scholar ].