title: Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience.
abstract: Gastrogastric fistula (GGF) is a known complication of gastric bypass surgery. Revisional surgery for GGF repair can be technically challenging. We describe our experience with endoscopic repair of small GGFs. A retrospective review was performed to identify patients in whom symptomatic GGF was repaired endoscopically at our institution between September 2004 and September 2008. At endoscopy, the fistulous margins were debrided using cold biopsy forceps or ablated using Argon Plasma Coagulation (APC). The fistula was then repaired with endoclips. Status of GGF repair was assessed intra-operatively, at 2 weeks by upper gastrointestinal (UGI) series, and at regular follow-up thereafter. GGF repair was attempted in eight female patients (mean age = 47 years). The average time interval between gastric bypass surgery and GGF presentation was 81 months. The presenting symptoms included nausea, vomiting, abdominal pain, and weight regain. The average duration of endoscopic procedure was 55 min. All GGFs were small (<20 mm). Endoscopic repair of GGF was successful intra-operatively in all patients. Two patients had failure of GGF repair at 2 weeks. Other two patients experienced recurrent symptoms after several weeks and had a delayed failure of GGF repair diagnosed by UGI series. Endoscopic repair has remained successful in four patients at 8-46 months follow-up. Endoscopic repair of small GGFs using endoclips is feasible. It must be considered as an option for management of small GGFs, given its safety, and ease of performance compared to revisional surgery.
authors.affiliation: Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, H034, P.O. Box 850, Hershey, PA 17033-0850, USA. abhardwaj@hmc.psu.edu
authors.forename: Atul
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Robert N
authors.initials: RN
authors.lastname: Cooney
authors.forename: Andrew
authors.initials: A
authors.lastname: Wehrman
authors.forename: Ann M
authors.initials: AM
authors.lastname: Rogers
authors.forename: Abraham
authors.initials: A
authors.lastname: Mathew
mesh_terms: D003646:Debridement; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome