PMID- 37397860
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230704
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 11
IP  - 6
DP  - 2023 Jun
TI  - Endoscopic closure versus surgical revision in the management of gastro-gastric 
      fistula following Roux-en-Y gastric bypass.
PG  - E629-E634
LID - 10.1055/a-2037-4764 [doi]
AB  - Background and study aims  Gastro-gastric fistulae (GGF) occur in 1.3 % to 6 % of 
      Rouxy-en-Y gastric bypass (RYGB) patients and can be associated with abdominal 
      pain, reflux, weight regain and onset of diabetes. Endoscopic and surgical 
      treatments are available without prior comparisons. The study aim was to compare 
      endoscopic and surgical treatment methods in RYGB patients with GGF. Patients and 
      methods  A retrospective matched cohort study of RYGB patients who underwent 
      endoscopic closure (ENDO) or surgical revision (SURG) for GGF. One-to-one 
      matching was performed based on age, sex, body mass index and weight regain. 
      Patient demographics, GGF size, procedural details, symptoms and 
      treatment-related adverse events (AEs) were collected. A comparison of symptom 
      improvement and treatment-related AEs was performed. Fisher's Exact, t -test and 
      Wilcoxon Rank Sum tests were performed. Results  Ninety RYGB patients with GGF 
      (45 ENDO, 45 matched SURG) were included. GGF symptoms included weight regain 
      (80 %), gastroesophageal reflux disease (71 %) and abdominal pain (67 %). At 6 
      months, the ENDO and SURG groups experienced 0.59 % and 5.5 % total weight loss 
      (TWL) ( P  = 0.0002). At 12 months, the ENDO and SURG groups experienced 1.9 % 
      and 6.2 % TWL ( P  = 0.007). Abdominal pain improved in 12 (52.2 %) ENDO and 5 
      (15.2 %) SURG patients at 12 months ( P  = 0.007). Diabetes and reflux resolution 
      rates were similar between groups. Treatment-related AEs occurred in four (8.9 %) 
      ENDO and 16 (35.6 %) SURG patients ( P  = 0.005), of which none and eight 
      (17.8%), respectively, were serious ( P  = 0.006). Conclusions  Endoscopic GGF 
      treatment produces greater improvement in abdominal pain and fewer overall and 
      serious treatment-related AEs. However, surgical revision appears to yield 
      greater weight loss.
CI  - The Author(s). This is an open access article published by Thieme under the terms 
      of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
      permitting copying and reproduction so long as the original work is given 
      appropriate credit. Contents may not be used for commercial purposes, or adapted, 
      remixed, transformed or built upon. 
      (https://creativecommons.org/licenses/by-nc-nd/4.0/).
FAU - Dolan, Russell D
AU  - Dolan RD
AD  - Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women's 
      Hospital, Boston, Massachusetts, United States.
FAU - Jirapinyo, Pichamol
AU  - Jirapinyo P
AD  - Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women's 
      Hospital, Boston, Massachusetts, United States.
FAU - Maahs, Ethan D
AU  - Maahs ED
AD  - Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women's 
      Hospital, Boston, Massachusetts, United States.
FAU - Thompson, Christopher C
AU  - Thompson CC
AD  - Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women's 
      Hospital, Boston, Massachusetts, United States.
LA  - eng
PT  - Journal Article
DEP - 20230629
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC10310440
COIS- Competing interests Dr. Jirapinyo has received research support from Apollo 
      Endosurgery and Fractyl and served as a consultant for Endogastric Solutions. Dr. 
      Thompson is a consultant and has received research support from Apollo 
      Endosurgery, received research support from Aspire Bariatrics, been a General 
      Partner with BlueFlame Healthcare Venture Fund, served as a consultant for and 
      received research support from Boston Scientific, been a consultant for 
      Covidien/Medtronic, is a founder, consultant and board member for Enterasense Ltd 
      and Envision Endoscopy, has received an institutional research grant from ERBE, 
      is a consultant/advisory board member for Fractyl, has served as a consultant for 
      and received a research grant from FujiFilm, is a consultant for and has received 
      an institutional research grant from GI Dynamics, is a founder, board member and 
      has an ownership interest in GI Windows, is a consultant and has received an 
      institutional research grant from Lumendi, is a consultant and has received 
      research support from Olympus/Spiration, and has served as a consultant and 
      advisory board member and received an institutional research grant from USGI 
      Medical.
EDAT- 2023/07/03 13:06
MHDA- 2023/07/03 13:07
PMCR- 2023/06/01
CRDT- 2023/07/03 11:39
PHST- 2021/11/17 00:00 [received]
PHST- 2022/05/09 00:00 [accepted]
PHST- 2023/07/03 13:07 [medline]
PHST- 2023/07/03 13:06 [pubmed]
PHST- 2023/07/03 11:39 [entrez]
PHST- 2023/06/01 00:00 [pmc-release]
AID - 10.1055/a-2037-4764 [doi]
PST - epublish
SO  - Endosc Int Open. 2023 Jun 29;11(6):E629-E634. doi: 10.1055/a-2037-4764. 
      eCollection 2023 Jun.