Bariatric postoperative fistula: a life-saving endoscopic procedure

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Endoscopic Procedures

Background:

• Gastric fistulas post-bariatric surgery present significant morbidity and mortality.
• Treatment is complicated by persistent abscesses and distal stenosis.
• Novel endoscopic stricturotomy/internal drainage offers a potential solution.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic stricturotomy/internal drainage for gastric fistulas.
• To determine if this procedure can avoid re-operation and allow early oral feeding.

Main Methods:

• Prospective, non-randomized study of 27 patients with gastric fistulas after Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, or duodenal switch.
• Treatment involved endoscopic internal drainage and stricturotomy, with balloon dilation for stenosis.
• Procedures were performed 15-30 days post-surgery.

Main Results:

• All 27 gastric fistulas closed successfully.
• Mean closure time was 18.11 days, with no mortality.
• Complications included bleeding (2 patients) and perforation (1 patient).

Conclusions:

• Endoscopic stricturotomy/internal drainage is a safe, feasible, and effective treatment for gastric fistulas.
• The procedure avoids re-operation, facilitates early oral feeding, and allows for prompt discharge.