title: Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention.
abstract: Gastrobronchial fistula (GBF) is a serious complication following bariatric surgery, whose treatment by thoracotomy and/or laparotomy involves a high morbidity rate. We present the outcomes of endoscopic management for GBF as a helpful technique for its healing process. This is a multicenter retrospective study of 15 patients who underwent gastric bypass (n = 10) and sleeve gastrectomy (n = 5) and presented GBF postoperatively (mean of 6.7 months). Ten patients developed lung abscess and were treated by antibiotic therapy (n = 10) and thoracotomy (n = 3). Abdominal reoperation was performed in nine patients for abscess drainage (n = 9) and/or ring removal (n = 4) and/or nutritional access (n = 6). The source of the GBF was at the angle of His (n = 14). Furthermore, 14 patients presented a narrowing of the gastric pouch treated by 20 or 30 mm aggressive balloon dilation (n = 11), stricturotomy or septoplasty (n = 10) and/or stent (n = 7). Fibrin glue was used in one patient. We performed, on average, 4.5 endoscopic sessions per patient. Endotherapy led to a 93.3% (14 out of 15) success rate in GBF closure with an average healing time of 4.4 months (range, 1-10 months), being shorter in the stent group (2.5 × 9.5 months). There was no recurrence during the average 27.3-month follow-up. A patient persisted with GBF, despite the fibrin glue application, and decided to discontinue it. GBF is a highly morbid complication, which usually arises late in the postoperative period. Endotherapy through different strategies is a highly effective therapeutic option and should be implemented early in order to shorten leakage healing time.
authors.affiliation: Universidade Federal de Pernambuco, Rua Vigário Barreto, 127/802-Graças, 52020-140, Recife, PE, Brazil. josembergcampos@gmail.com
authors.forename: Josemberg Marins
authors.initials: JM
authors.lastname: Campos
authors.forename: Eduardo Franca
authors.initials: EF
authors.lastname: Pereira
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Evangelista
authors.forename: Luciana
authors.initials: L
authors.lastname: Siqueira
authors.forename: Manoel Galvão
authors.initials: MG
authors.lastname: Neto
authors.forename: Victor
authors.initials: V
authors.lastname: Dib
authors.forename: Marcelo
authors.initials: M
authors.lastname: Falcão
authors.forename: Vitor
authors.initials: V
authors.lastname: Arantes
authors.forename: Diego
authors.initials: D
authors.lastname: Awruch
authors.forename: Walton
authors.initials: W
authors.lastname: Albuquerque
authors.forename: João
authors.initials: J
authors.lastname: Ettinger
authors.forename: Almino
authors.initials: A
authors.lastname: Ramos
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Ferraz
mesh_terms: D000328:Adult; D001983:Bronchial Fistula / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D015390:Gastric Bypass / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies