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. 2022 Feb;32(2):342-348.
doi: 10.1007/s11695-021-05794-z. Epub 2021 Nov 15.

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

Alessandra D'Alessandro  1   2 , Giovanni Galasso  2 , Francesco Paolo Zito  3 , Cristiano Giardiello  4 , Fabrizio Cereatti  1   5 , Roberto Arienzo  6 , Filippo Pacini  6 , Jean-Marc Chevallier  6 , Gianfranco Donatelli  7
Affiliations

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

Alessandra D'Alessandro et al. Obes Surg. 2022 Feb.

Abstract

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.

Keywords: Double pigtail stent; EID; Endoscopic internal drainage; Gastro-bronchial fistula; Gastro-colic fistula; Post-bariatric surgery complications; Sleeve gastrectomy.

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