Over-the-scope clip for endoscopic closure of gastrogastric fistulae.
BACKGROUND
Gastrogastric fistulae (GGF) are a well-known complication of Roux-en-Y gastric bypass (RYGB). Endoscopic approaches for closure of GGF have gained popularity, but with limited data and efficacy.


OBJECTIVE
The primary arm of the study was to evaluate the safety and efficacy of the endoscopic closure of GGF using the over-the-scope clip (OTSC) device.


METHODS
University hospital, United States METHODS: This is a retrospective review of consecutive patients at a single academic center from September 2013 to December 2014 who underwent upper endoscopy with attempted OTSC placement for closure of GGF related to RYGB. Preprocedural, procedural, and postprocedural data were collected. Outcome measures included technical success, primary success, and long-term success.


RESULTS
A total of 14 patients underwent attempted GGF closure using OTSC. Twelve of the 14 patients (85.7%) had technical success. Four patients were lost to follow-up. Primary success was achieved in 5 of the 10 patients (50%) in which it was assessed, either by upper gastrointestinal series or endoscopy. One of the 5 patients who had primary success was then lost to follow-up. Of the 4 patients in whom primary success was achieved and had long-term follow up, 75% (n = 3) achieved long-term success at a mean follow-up of 6.6 months from initial OTSC placement (range, 3-9), making for a long-term success rate of 33% (3/9). There were no reported complications.


CONCLUSIONS
OTSC closure of small GGF is feasible, safe, and offers a reasonable alternative to surgical revision. Large GGF may undergo attempted endoscopic closure, acknowledging a high failure rate.
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: brniland@gmail.com.
Benjamin
B
Niland
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.
Andrew
A
Brock
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D005747:Gastric Fistula / Q000601:surgery*; D005773:Gastroscopy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D061214:Patient Safety; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome
GGF; Ovesco; gastrogastric fistula; gastrogastric fistulae; over-the-scope clip