West Virginia University Health Sciences Center Morgantown, WV, United States
Momin Shah-Khan, MD1, Yousaf Hadi, MD2, Shyam Thakkar, MD1, Shailendra Singh, MD2 1West Virginia University Health Sciences Center, Morgantown, WV; 2West Virginia University, Morgantown, WV
Introduction: Development of a gastrogastric fistula (GGF) between the gastric pouch and gastric remnant is a known complication of Roux-en-Y gastric bypass (RYGB). Such fistulas can lead to weight loss failure and progressive weight gain. While these fistulas can be closed endoscopically, permanent closure is rare and they often recur. We demonstrate the management of weight loss failure with endoscopic sleeve gastroplasty (ESG) of the remnant stomach in a patient with a gastrogastric fistula following RYGB prior to fistula closure.
Case Description/Methods: A 72 year old female with a history of RYGB in 1981 complicated by a history of a chronic GGF with previously failed endoscopic attempts at fistula closure was referred to our practice for management of continued weight loss failure. Index EGD was performed and revealed a small 1 cm GGF in the proximal gastric pouch and a large 3 cm GGF in the distal gastric pouch. After a discussion of the options, the patient elected to proceed with ESG of the remnant stomach prior to endoscopic closure of the gastrogastric fistulas. On repeat EGD, the gastric remnant was entered through the large GGF and argon plasma coagulation (APC) was performed along the greater and lesser curvatures. Next the endoscopic suturing device (Endostitch, Apollo Endosurgery, Austin, TX, USA) was used to suture the remnant stomach. A “U” shaped suture pattern was performed starting at the anterior surface of the distal stomach body followed by the greater curvature and then the posterior wall. Suturing was then repeated in the opposite direction from the posterior wall to the greater curvature and finished on the anterior wall. A total of 6 sutures were placed. Next, the proximal GGF was treated with APC to promote tissue apposition and endoscopically sutured shut using 3 sutures. Attention was then returned to the distal GGF and the opening tract was treated with APC and then endoscopically sutured with 4 sutures. At the completion of the procedure, the gastrogastric fistulas appeared closed and the procedure was complete. At one month follow up the patient reports a 12 lbs weight loss with early satiety.
Discussion: Weight loss failure following the development of gastrogastric fistulas in RYGB patients can be challenging as the fistulas seldomly remain closed. Our case demonstrates that in patients with a GGF following RYGB, ESG of the remnant stomach is a feasible and effective option in the management of weight gain in such cases.
Momin Shah-Khan indicated no relevant financial relationships.
Yousaf Hadi indicated no relevant financial relationships.
Shyam Thakkar indicated no relevant financial relationships.
Shailendra Singh indicated no relevant financial relationships.
Momin Shah-Khan, MD1, Yousaf Hadi, MD2, Shyam Thakkar, MD1, Shailendra Singh, MD2. P1750 - Endoscopic Sleeve Gastroplasty of the Remnant Stomach in a Patient With Roux-en-Y Gastric Bypass and Gastrogastric Fistula, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.