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

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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.

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Authors and Affiliations

  1. Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l’Abbé G. Hénocque, 75013, Paris, France

    Alessandra D’Alessandro, Fabrizio Cereatti & Gianfranco Donatelli

  2. Endoscopy Unit, Pineta Grande Hospital, Castel Volturno, CE, Italy

    Alessandra D’Alessandro & Giovanni Galasso

  3. Gastroenterology and Digestive Endoscopy, AORN Cardarelli, Napoli, Italy

    Francesco Paolo Zito

  4. Department of General, Emergency and Metabolic Surgery, Pineta Grande Hospital, Castel Volturno, CE, Italy

    Cristiano Giardiello

  5. Department of Gastroenterology and Digestive Endoscopy, Castelli Hospital, Ariccia (Rm), Italy

    Fabrizio Cereatti

  6. Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France

    Roberto Arienzo, Filippo Pacini & Jean-Marc Chevallier

Authors
  1. Alessandra D’Alessandro
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  2. Giovanni Galasso
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  3. Francesco Paolo Zito
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  4. Cristiano Giardiello
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  5. Fabrizio Cereatti
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  6. Roberto Arienzo
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  7. Filippo Pacini
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  8. Jean-Marc Chevallier
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  9. Gianfranco Donatelli
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Corresponding author

Correspondence to Gianfranco Donatelli.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Key Points

• Persistence of collection below the diaphragm may determine a pathologic communication between the stomach and the bronchial tree or the transverse/left angle colon causing gastro-bronchial (GBF) or gastro-colic fistula (GCF), respectively. The complete drainage of peri-gastric collections is mandatory to treat acute post-surgical complication after sleeve gastrectomy (SG) and prevent the onset of chronic fistulas.

• Treatment of gastro-bronchial and gastro-colic fistulas after bariatric surgery represents a challenge for clinicians and requires a multidisciplinary approach

• Endoscopic internal drainage (EID) permits to both drain peri-gastric collections and induce second intention healing of gastric defects.

• Adequate nutritional support should represent a mainstay of therapy in the management of post-bariatric leaks and fistula

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D’Alessandro, A., Galasso, G., Zito, F.P. et al. Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy. OBES SURG 32, 342–348 (2022). https://doi.org/10.1007/s11695-021-05794-z

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  • DOI: https://doi.org/10.1007/s11695-021-05794-z

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