title: Endoscopic treatment of fistula after sleeve gastrectomy: results of a multicenter retrospective study.
abstract: OBJECTIVE
  Fistula is the main complication of laparoscopic sleeve gastrectomy (LSG), for which healing is difficult to achieve. The aims of the study were to evaluate the efficacy of interventional endoscopy for post-LSG fistula treatment, to evaluate various endoscopic techniques used and identify their complications, and to identify predictive factors of healing following endoscopic treatment.
  
  
  METHODS
  This retrospective multicenter study included patients with post-LSG fistula. Therapeutic procedures were evaluated, taking into account complications and healing times. Endoscopic procedures were considered to have promoted healing if no other surgical procedure was performed. Predictive factors of healing were identified by univariate and multivariate analysis.
  
  
  RESULTS
  A total of 110 patients were included, of whom 6 (5.5 %) healed spontaneously, 81 (73.6 %) healed following endoscopic treatment, and 19 (17.3 %) healed following surgery. Healing rates following endoscopic treatment were 84.4 % in the first 6 months of treatment (65/77), 52.4 % for treatment lasting 6 - 12 months (11/21), and 41.7 % after 12 months of treatment (5/12). A drainage procedure (surgical, endoscopic, or percutaneous) was performed in 92 patients (83.6 %). A total of 177 esogastric stents were placed in 88 patients (80.0 %). Surgical debridement, clip placement, glue sealing, and plug placement were also performed. Multivariate analysis identified four predictive factors of healing following endoscopic treatment: interval < 21 days between fistula diagnosis and first endoscopy (P = 0.003), small fistula (P = 0.01), interval between LSG and fistula ≤ 3 days (P = 0.01), no history of gastric banding (P = 0.04).
  
  
  CONCLUSIONS
  Endoscopic treatment facilitated healing of post-LSG fistula in 74 % of patients. Early endoscopic treatment increased the likelihood of success, and was most effective during the first 6 months of management. After this point, surgical treatment should be considered.
authors.affiliation: Service d'Hépato-Gastroentérologie B, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Christophorou
authors.affiliation: Service d'Hépato-Gastroentérologie B, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Valats
authors.affiliation: Service d'Hépato-Gastroentérologie B, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France.
authors.forename: Natalie
authors.initials: N
authors.lastname: Funakoshi
authors.affiliation: Département d'Information Médicale, CHU Montpellier, Montpellier, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Duflos
authors.affiliation: Département d'Information Médicale, CHU Montpellier, Montpellier, France.
authors.forename: Marie-Chistine
authors.initials: MC
authors.lastname: Picot
authors.affiliation: Service de Gastroentérologie et Endoscopie Digestive, Clinique du Diaconat, Mulhouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vedrenne
authors.affiliation: Service de Gastroentérologie et endoscopie digestive, Hôpital Cochin, APHP Paris, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Prat
authors.affiliation: Service d'Hépato-Gastroentérologie, Clinique La Louvière, Lille, France.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Bulois
authors.affiliation: Service d'Hépato-Gastroentérologie, Hôpital Claude Huriez, CHU Lille, Lille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Branche
authors.affiliation: Service d'Hépato-Gastroentérologie, Hôpital Claude Huriez, CHU Lille, Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Decoster
authors.affiliation: Service d'Hépato-Gastroentérologie, Hôpital Hôtel Dieu, CHU Nantes, Nantes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.affiliation: Service d'Hépato-Gastroentérologie, APHP, Hôpital Henri Mondor, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Charachon
authors.affiliation: Service d'Hépato-Gastroentérologie B, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Pineton De Chambrun
authors.affiliation: Service d'Hépato-Gastroentérologie B, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France.
authors.forename: David
authors.initials: D
authors.lastname: Nocca
authors.affiliation: Service d'Hépato-Gastroentérologie B, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Bauret
authors.affiliation: Service d'Hépato-Gastroentérologie B, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanc
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016154:Digestive System Fistula / Q000209:etiology / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult