Endoscopic closure of gastrogastric fistulas by using a tissue apposition system (with videos)

Gastrointest Endosc. 2010 Mar;71(3):606-11. doi: 10.1016/j.gie.2009.09.044. Epub 2009 Dec 16.


Background: Gastrogastric fistulas (GGFs) are seen in 1.5% to 12.5% of patients after Roux-en-Y gastric bypass (RYGB) bariatric surgery, often leading to failure to lose adequate weight.

Objective: The aim of this study was to assess the feasibility, safety, and percentage of successful primary endoluminal closures of GGFs by using a recently developed tissue apposition system in combination with local mucosectomy.

Design: A feasibility and outcome study following institutional review board protocol.

Setting: Tertiary referral teaching hospital, Legacy Health System, Portland, Oregon.

Interventions: A combination of mucosectomy and nonresorbable tissue apposition is used to achieve a permanent closure of the GGF.

Patients: Four patients with 5 GGFs after RYGB; the mean fistula diameter of was 18.6 mm (range 10-30 mm).

Results: Primary closure rate (1 endoscopic session) of 5 GGFs was 100%. The mean procedure time was 88.5 minutes. One to 4 pairs of tissue anchors were used to close the fistulas. The mean time for performing mucosectomy was 21.6 minutes (range 8-42 minutes) and 39.6 minutes (range 12-58 minutes) for fistula closure. Estimated blood loss was on average 2 mL (range 0-5 mL). No complications were recorded. Early success (3 months), as evidenced by early satiety and weight loss, was noted for 3 of 4 patients. After 3 months, only the smallest fistula (10 mm) was still completely closed, and after 6 months, it also showed a pinhole opening.

Conclusion: It was feasible to close all fistulas endoscopically without complications. Permanent closure of GGFs could not be achieved.

MeSH terms

  • Adult
  • Endoscopy, Gastrointestinal* / methods
  • Equipment Design
  • Feasibility Studies
  • Female
  • Gastric Bypass / adverse effects*
  • Gastric Fistula / surgery*
  • Gastric Mucosa / surgery
  • Humans
  • Male
  • Middle Aged
  • Stomach / surgery*
  • Suture Anchors*
  • Video Recording