Endoscopic Repair of Small Symptomatic Gastrogastric Fistulas After Gastric Bypass Surgery: A Single Center Experience

Bhardwaj, A.; Cooney, Robert N.; Wehrman, Andrew; Rogers, Ann M.; Mathew, Abraham

doi:10.1007/s11695-010-0180-5

Cited by 36 publications

(9 citation statements)

References 30 publications

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“…GGF usually requires surgical repair with removal of the fistula and surrounding necrotic tissue, potentially resulting in a complete remnant gastrectomy and a decreased gastric pouch size [4,46,47]. This rare clinical complication may be accompanied with weight regain and/or diabetes relapse [10].…”

Section: Discussionmentioning

confidence: 99%

Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels

et al. 2013

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Purpose Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the ‘old route’ rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair. Materials and Methods Seven post-GBP subjects diagnosed with GGF were studied before and 4 months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1 year post-GBP. All subjects underwent a 50g oral glucose tolerance test and blood was collected from 0-120minutes for glucose, insulin, ghrelin, PYY3-36, GIP, and GLP-1 levels. Results Four months after GGF repair subjects lost 6.0 ±3.9kg and had significantly increased postprandial PYY3-36 levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY3-36 levels were no longer lower than the post-GBP group. Conclusions These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.

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Section: Discussionmentioning

confidence: 99%

Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels

et al. 2013

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“…The technology required and endoscopic skill set needed to accomplish these endoluminal procedures, though, are not widely available and are considered as investigational at this time. (380 [EL 3, SS]; 381 [EL 3, SS]; 382 [EL 3, CCS]; 383 [EL 3, SCR], 384 [EL 3, SCR]).…”

Section: Evidence Basementioning

confidence: 99%

Clinical Practice Guidelines For The Perioperative Nutritional, Metabolic, And Nonsurgical Support Of The Bariatric Surgery Patient2013 Update: Cosponsored By American Association Of Clinical Endocrinologists, The Obesity Society, And American Society For Metabolic & Bariatric Surgery

et al. 2013

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The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE- TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

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“…In this series, GGF was identified on average 31 months after primary surgery, earlier than other series. 5,15 As the follow-up protocol demands routine sequential postoperative UGE for all patients, it may have led to an earlier diagnosis. Although it might be expensive to recommend routine UGE in the postoperative period, centers that apply this protocol might have earlier identification of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…A series of conservative, 4,6,7,11,16 endoscopic, 5,6,15 and surgical management studies 4,6,8,15,16 was analyzed, with different success rates.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic, Conservative, and Surgical Treatment of the Gastrogastric Fistula: The Efficacy of a Stepwise Approach and Its Long-Term Results

CamposJosemberg¹,

Galvão²,

MartinsJoão³

et al. 2015

Bariatric Surgical Practice and Patient Care

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Background: Treatment of gastrogastric fistula (GGF) has not been consensual. The aim of this study is to evaluate the efficacy of a stepwise approach of GGF in the long term. Methods: This is a retrospective case-series study. Thirty-one patients underwent open (71%) or laparoscopic (29%) Roux-en-Y gastric bypass (RYGB), where 20 (64.5%) had a banded pouch. Those 31 cases were referred to the authors' clinic for GGF treatment. The mean time between the primary surgery and GGF diagnosis by endoscopy or radiography was 31 months. Outcomes were evaluated after conservative, endoscopic, and surgical treatment. Mean follow-up was 39.7 months (10-97 months). Results: Patients were referred presenting weight regain (100%), epigastric pain (51.6%), and upper digestive hemorrhage (9.6%) due to marginal ulcer (35.5%). GGF was located at the angle of His (51.6%) and two other sites (gastric body and close to the gastrojejunal anastomosis). Etiology was defined in 27 (87%) due to previous acute gastric leak (54.8%) and band erosion (32.3%). Treatment for GGF was conservative (n = 11; healing = 2, 18.2%) and endoscopic (n = 6; healing = 4, 66.7%). In the surgical group (n = 14), fistula transection by laparoscopy (n = 6) and by laparotomy (n = 8) were carried out. In this last group, a remnant gastrectomy was done (n = 5). Fistula closure was achieved in 13 (92.9%) patients in the surgical group, which had two cases of acute fistula treated by endoscopy. Overall outcomes were symptom control and weight loss. Conclusions: GGF has been effectively treated by revisional surgery. Endoscopic management in selected situation has a relatively high success rate.

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Endoscopic Repair of Small Symptomatic Gastrogastric Fistulas After Gastric Bypass Surgery: A Single Center Experience

Cited by 36 publications

References 30 publications

Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels

Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels

Clinical Practice Guidelines For The Perioperative Nutritional, Metabolic, And Nonsurgical Support Of The Bariatric Surgery Patient2013 Update: Cosponsored By American Association Of Clinical Endocrinologists, The Obesity Society, And American Society For Metabolic & Bariatric Surgery

Endoscopic, Conservative, and Surgical Treatment of the Gastrogastric Fistula: The Efficacy of a Stepwise Approach and Its Long-Term Results

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