Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy

• Published in: Obesity surgery 2022-02, Vol.32 (2), p.342-348
• Main Authors: D’Alessandro, Alessandra, Galasso, Giovanni, Zito, Francesco Paolo, Giardiello, Cristiano, Cereatti, Fabrizio, Arienzo, Roberto, Pacini, Filippo, Chevallier, Jean-Marc, Donatelli, Gianfranco
• Format: Article
• Language: English
• Subjects: Endoscopy; Fistula; Gastrointestinal surgery; Medicine; Medicine & Public Health; Original Contributions; Surgery
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-021-05794-z

Background Gastro-bronchial and gastro-colic fistulas (GB-GC) represent a rare, but serious complication after laparoscopic sleeve gastrectomy (LSG). The aim of this study is to evaluate the efficacy of endoscopic first-line approach with endoscopic internal drainage (EID) by inserting double pigtail stents (DPS) Methods We retrospectively analyzed data from 40 consecutive patients referred at two tertiary centers for gastro-bronchial ( N =30) and gastrocolic ( N =10) fistulas following LSG. Nineteen patients previously experienced emergency surgical drainage. The mean interval between the index surgery and endoscopic fistula treatment was 265.6±521 days. Results Healing of the fistulous tract was achieved in 19 patients (47.5%), with complete resolution at an average follow-up of 16 months. Mean time of treatment duration was 157.8±141 days with 5.0±2.9 endoscopic sessions. No major adverse events were registered. Conclusions Despite complete fistula healing was achieved in less than 50% of our population, EID for GB/GC fistula after LSG still represents the most conservative approach with low complications rate. Previous surgical drainage seems to be a positive prognostic factor for endoscopic healing. While the longer the interval between the index surgery and endoscopic treatment, the lower was the rate of treatment success. Graphical abstract