Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure

Publication date: Available online 25 July 2017
Source:Gastrointestinal Endoscopy
Author(s): Diane Lorenzo, Théophile Guilbaud, Jean Michel Gonzalez, Alban Benezech, Anne Dutour, Sandrine Boullu, Stéphane Berdah, Thierry Bège, Marc Barthet
Background and AimsPost-sleeve gastrectomy fistulas (PSGF) are major adverse events of bariatric surgery. The endoscopic management strategy evolved from closure to internal drainage (ID) after 2013. The main objective was to evaluate and compare these different approaches.MethodsThis retrospective study included all patients treated for PSGF in a referral center. "Closure" management was defined as initial treatment using covered-metal-stent and/or endoclips. ID management was defined as initial treatment by nasocystic drain and/or double-pigtail-stent.Results100 patients (women: N=78; mean age±standard deviation: 42 ± 12 years) were included between 2007 and 2015. The mean delay between SG and the first endoscopy was 82 ± 125 days. The overall success of endoscopic treatment was 86% within 6 ± 27months. Two patients died. Primary success of ID and closure management occurred in 19/22 (86%) and 49/77 (63%) patients, respectively. Among patients in failure for closure management, 22 had secondary ID (18 being successful). Success of initial management was significantly higher for ID (p=0.043). Factors associated with failure of closure management were in multivariable analysis: collection >5 cm (p=0.013). Factors associated with a time over 6 months for achieving the leakage closure were in multivariable analysis: reoperation before endoscopy (p=0.044) and purulent flowing at endoscopy (p=0.043).ConclusionsEndoscopic management of PSGF was successful in 86% of the cases. In case of collection larger than 5 cm, an internal drainage should be proposed first. A surgical reintervention before endoscopy is associated with longer care.



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