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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(06): E629-E634
DOI: 10.1055/a-2037-4764
Original article

Endoscopic closure versus surgical revision in the management of gastro-gastric fistula following Roux-en-Y gastric bypass

Russell D. Dolan
1   Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
Pichamol Jirapinyo
1   Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
Ethan D. Maahs
1   Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
Christopher C. Thompson
1   Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
› Author AffiliationsSupported by: National Institutes of Health P30 DK034854
Supported by: T32 DK007533
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Abstract

Background and study aims Gastro-gastric fistulae (GGF) occur in 1.3 % to 6 % of Rouxy-en-Y gastric bypass (RYGB) patients and can be associated with abdominal pain, reflux, weight regain and onset of diabetes. Endoscopic and surgical treatments are available without prior comparisons. The study aim was to compare endoscopic and surgical treatment methods in RYGB patients with GGF.

Patients and methods A retrospective matched cohort study of RYGB patients who underwent endoscopic closure (ENDO) or surgical revision (SURG) for GGF. One-to-one matching was performed based on age, sex, body mass index and weight regain. Patient demographics, GGF size, procedural details, symptoms and treatment-related adverse events (AEs) were collected. A comparison of symptom improvement and treatment-related AEs was performed. Fisher’s Exact, t-test and Wilcoxon Rank Sum tests were performed.

Results Ninety RYGB patients with GGF (45 ENDO, 45 matched SURG) were included. GGF symptoms included weight regain (80 %), gastroesophageal reflux disease (71 %) and abdominal pain (67 %). At 6 months, the ENDO and SURG groups experienced 0.59 % and 5.5 % total weight loss (TWL) (P = 0.0002). At 12 months, the ENDO and SURG groups experienced 1.9 % and 6.2 % TWL (P = 0.007). Abdominal pain improved in 12 (52.2 %) ENDO and 5 (15.2 %) SURG patients at 12 months (P = 0.007). Diabetes and reflux resolution rates were similar between groups. Treatment-related AEs occurred in four (8.9 %) ENDO and 16 (35.6 %) SURG patients (P = 0.005), of which none and eight (17.8%), respectively, were serious (P = 0.006).

Conclusions Endoscopic GGF treatment produces greater improvement in abdominal pain and fewer overall and serious treatment-related AEs. However, surgical revision appears to yield greater weight loss.



Publication History

Received: 17 November 2021

Accepted after revision: 09 May 2022

Article published online:
29 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Rosenthal RJ, Szomstein S, Kennedy CI. et al. Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. Obes Surg 2006; 16: 119-124
    CrossrefPubMedGoogle Scholar
  • 2 American Society of Metabolic and Bariartic Surgery. Estimate of Bariatric Surgery Numbers, 2011–2020. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers
    PubMedGoogle Scholar
  • 3 Robert M, Espalieu P, Pelascini E. et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet 2019; 393: 1299-1309
    CrossrefPubMedGoogle Scholar
  • 4 Hayoz C, Hermann T, Raptis DA. et al. Comparison of metabolic outcomes in patients undergoing laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy – a systematic review and meta-analysis of randomised controlled trials. Swiss Med Wkly 2018; 148: w14633
    CrossrefPubMedGoogle Scholar
  • 5 Lager CJ, Esfandiari NH, Luo Y. et al. Metabolic Parameters, weight loss, and comorbidities 4 years after Roux-en-Y Gastric bypass and sleeve gastrectomy. Obes Surg 2018; 28: 3415-3423
    CrossrefPubMedGoogle Scholar
  • 6 Griffith PS, Birch DW, Sharma AM. et al. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity. Can J Surg 2012; 55: 329-336
    CrossrefPubMedGoogle Scholar
  • 7 Yao DC, Stellato TA, Schuster MM. et al. Gastrogastric fistula following Roux-en-Y bypass is attributed to both surgical technique and experience. Am J Surg 2010; 199: 382-385 ; discussion 385–386
    CrossrefPubMedGoogle Scholar
  • 8 Cucchi SG, Pories WJ, MacDonald KG. et al. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg 1995; 221: 387-391
    CrossrefPubMedGoogle Scholar
  • 9 Tucker ON, Szomstein S, Rosenthal RJ. Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg 2007; 11: 1673-1679
    CrossrefPubMedGoogle Scholar
  • 10 Chahine E, Kassir R, Dirani M. et al. Surgical management of gastrogastric fistula after roux-en-y gastric bypass: 10-year experience. Obes Surg 2018; 28: 939-944
    CrossrefPubMedGoogle Scholar
  • 11 Fernandez-Esparrach G, Lautz DB, Thompson CC. Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis 2010; 6: 282-288
    CrossrefPubMedGoogle Scholar
  • 12 Bhardwaj A, Cooney RN, Wehrman A. et al. Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience. Obes Surg 2010; 20: 1090-1095
    CrossrefPubMedGoogle Scholar
  • 13 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 14 Ko CY, Hall BL, Hart AJ. et al. The American College of Surgeons National Surgical Quality Improvement Program: achieving better and safer surgery. Jt Comm J Qual Patient Saf 2015; 41: 199-204
    PubMedGoogle Scholar
  • 15 American College of Surgeons. National Surgical Quality Improvement Program. https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/
    PubMedGoogle Scholar
  • 16 OʼBrien CS, Wang G, McGinty J. et al. Effects of gastrogastric fistula repair on weight loss and gut hormone levels. Obes Surg 2013; 23: 1294-1301
    CrossrefPubMedGoogle Scholar
  • 17 Merrifield BF, Lautz D, Thompson CC. Endoscopic repair of gastric leaks after Roux-en-Y gastric bypass: a less invasive approach. Gastrointest Endosc 2006; 63: 710-714
    CrossrefPubMedGoogle Scholar
  • 18 Júnior WS, Pitanga CK, Borges CN. et al. Treatment of gastrogastric fistula after Roux-en-Y gastric bypass: surgery combined with gastroscopy. Obes Surg 2007; 17: 836-838
    CrossrefPubMedGoogle Scholar
  • 19 Ribeiro-Parenti L, De Courville G, Daikha A. et al. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis 2017; 13: 243-248
    CrossrefPubMedGoogle Scholar