Gastro-gastric fistulas are uncommon complications of bariatric bypass surgery, but
their management can be challenging [1]
[2]
[3]. We report a case of chronic gastro-gastric fistula after one-anastomosis gastric
bypass (OAGB) treated with a lumen-apposing metal stent (LAMS), with the aim of presenting
a viable treatment solution to the initial problem.
A 52-year-old woman presented with a chronic fistula after OAGB. The index procedure
had been performed in another hospital and had been complicated by sepsis and pouch
staple line leakage. The patient underwent surgical drainage, while the endoscopic
examination showed an 8-mm orifice. An esophagogastric self-expandable metal stent
had been placed, which migrated distally on day 10 and was then removed. Surprisingly,
no further attempts were made to close the fistula.
A few months after surgery, the patient presented to our care; she was on parenteral
nutrition and still had surgical drains in place. An abdominal computed tomography
(CT) scan with Gastrografin and an upper gastrointestinal endoscopy showed a chronic
fistula, with leakage into the peritoneal cavity between the gastric pouch and the
remnant. As a result, a lumen-apposing metal stent (LAMS; 15 × 10-mm Hot-Axios; Boston
Scientific, Massachusetts, USA) was placed between the gastric pouch and gastric remnant
to close the leakage ([Video 1]). No complications occurred. A follow-up CT scan and a gastric transit with Gastrografin
showed complete closure of the leakage and rechanneling of the two structures. The
patient was commenced on oral food intake and was discharged the day after the procedure.
The LAMS was removed after 1 month.
An over-the-wire lumen-apposing metal stent is placed for the management of a chronic
fistula after one-anastomosis gastric bypass.Video 1
At the 1-year follow-up, an endoscopic evaluation was performed, which revealed the
persistence of the gastro-gastric fistula, with no evidence of leakage. The patient's
weight remained stable, and it was decided that suturing of the gastro-gastric fistula
was unnecessary, as it was no longer clinically relevant. The patient remains in excellent
condition, with her weight stable 2 years after the procedure.
Endoscopy_UCTN_Code_TTT_1AO_2AI
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
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by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
