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Novel Endoscopic Management of a Chronic Gastro-Gastric Fistula Using a Cardiac Septal Defect Occluder

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Abstract

Purpose

Closure of GG fistulas after RYGB is challenging due to epithelialization of the tract. Common endoscopic therapies are less efficacious than surgical revision, which is unfortunately fraught with high morbidity and mortality. Cardiac septal defect occluders (CSDO) have been successfully used for the management of gastrointestinal fistulas, but use has never been reported in management of GG fistulas. Thus, we describe the first off-label use of CSDO for the treatment of a GG fistula.

Materials and Methods

Endoscopy and fluoroscopic examination determined the appropriate size of CSDO for closure. A guidewire was placed in the remnant stomach followed by placement of the delivery system. Then, under fluoroscopy, we deployed the first flange of the CSDO in the remnant stomach. Then, under fluoroscopy and endoscopic visualization, the second flange is deployed in the gastric pouch.

Results

A 51-year-old woman, status-post RYGB in 2008, presented with a 6-month history of weight regain and reflux. She had regained weight to 84 kg (BMI = 32 kg/m2) when she was found to have a GG fistula. She underwent successful CSDO placement and, 3 months later, had lost 10 kg with significant improvement in her reflux. Repeat evaluation confirmed successful fistula closure.

Conclusion

The use of CSDO was technically feasible and appeared to be effective and safe. Future studies should continue to investigate the role of CSDO in management of this challenging condition.

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References

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Author information

Authors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Gastrointestinal Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Rua Enéas de Carvalho Aguiar, 255, São Paulo, SP, 05679-065, Brazil

    Diogo Turiani Hourneaux de Moura, Alberto Machado da Ponte-Neto, Epifânio Silvino do Monte Junior, Igor Braga Ribeiro & Eduardo Guimarães Hourneaux De Moura

  2. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Diogo Turiani Hourneaux de Moura, Kelly E. Hathorn & Christopher C. Thompson

  3. Hospital das Clínicas de Caracas, Caracas, Venezuela

    Alberto Baptista

Authors
  1. Diogo Turiani Hourneaux de Moura
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  2. Alberto Machado da Ponte-Neto
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  3. Kelly E. Hathorn
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  4. Epifânio Silvino do Monte Junior
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  5. Alberto Baptista
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  6. Igor Braga Ribeiro
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  7. Christopher C. Thompson
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  8. Eduardo Guimarães Hourneaux De Moura
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Corresponding author

Correspondence to Diogo Turiani Hourneaux de Moura.

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Conflict of Interest

Christopher C. Thompson reports fee as a consultant for Boston Scientific, USGI Medical, Olympus, Fractyl Labs, and Apollo Endosurgery.

Eduardo Guimarães Hourneaux de Moura is a consultant for Boston Scientific and Olympus.

All other authors declare that they have no conflict of interest.

Ethical Approval

Institutional Review Board of the Hospital approved the study. An informed consent was signed by the patient before the procedure.

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de Moura, D.T.H., da Ponte-Neto, A.M., Hathorn, K.E. et al. Novel Endoscopic Management of a Chronic Gastro-Gastric Fistula Using a Cardiac Septal Defect Occluder. OBES SURG 30, 3253–3254 (2020). https://doi.org/10.1007/s11695-020-04616-y

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  • DOI: https://doi.org/10.1007/s11695-020-04616-y

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