Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Surg Obes Relat Dis. 2010 May-Jun;6(3):282-8. doi: 10.1016/j.soard.2010.02.036. Epub 2010 Feb 20.
Gastrogastric fistulas (GGFs) are a well-known complication of Roux-en-Y gastric bypass. Surgical repair of such fistulas is technically difficult, with significant associated morbidity. The aim of the present study was to evaluate the efficacy of endoscopic GGF closure at a university hospital in the United States.
Patients with Roux-en-Y gastric bypass and confirmed GGFs on esophagogastroduodenoscopy or barium study. Endoscopic repair was performed with the EndoCinch suturing system (group 1) or clips (group 2). All patients were followed up in the outpatient clinic or interviewed by telephone at 1, 6, and 18 months after the procedure, then as indicated by symptoms.
A total of 95 patients were included in the present series (group 1, n = 71, 75%; group 2, n = 24, 25%). The mean GGF size was significantly larger in group 1 than in group 2 (14.5 +/- 8.7 versus 7.7 +/- 6, P = .01). An average of 2.2 sutures or 3 clips (range 2-7) was used. Complete initial GGF closure was achieved in 90 patients (95%), with reopening in 59 (65%) an average of 177 +/- 202 days. The average follow-up was 395 +/- 49 days, with 22 patients lost to follow-up. Two significant complications were reported (bleeding and an esophageal tear). None of the GGFs with an initial size >20 mm remained closed during the follow-up period compared with 10 (32%) of the 31 fistulas <or=10 mm in diameter remained closed.
Peroral endoscopic repair of postbariatric GGFs is technically feasible and safe but with limited durability. The fistula size predicted for long-term outcomes, with the best results seen in fistulas <or=10 mm in diameter.
胃胃瘘（Gastrogastric fistulas，GGFs）是 Roux-en-Y 胃旁路术的一种常见并发症。此类瘘管的手术修复技术难度大，相关发病率高。本研究旨在评估美国一所大学医院内镜 GGF 闭合的疗效。
患者行 Roux-en-Y 胃旁路术，经食管胃十二指肠镜或钡餐检查证实存在 GGF。采用 EndoCinch 缝合系统（第 1 组）或夹闭（第 2 组）进行内镜修复。所有患者在术后 1、6 和 18 个月进行门诊随访或电话随访，然后根据症状进行随访。
本系列共纳入 95 例患者（第 1 组 71 例，75%；第 2 组 24 例，25%）。第 1 组的 GGF 平均直径明显大于第 2 组（14.5±8.7 毫米比 7.7±6 毫米，P=.01）。平均使用 2.2 个缝线或 3 个夹闭器（范围 2-7）。90 例（95%）患者初次 GGF 闭合完全，59 例（65%）患者在平均 177±202 天后再次开放。平均随访时间为 395±49 天，有 22 例患者失访。报告了 2 例严重并发症（出血和食管撕裂）。在随访期间，与初始直径≤10 毫米的 31 例瘘管中仍有 10 例（32%）闭合相比，直径>20 毫米的 GGF 无 1 例闭合。
经口内镜修复肥胖症患者的 GGF 是可行且安全的，但耐久性有限。瘘管大小预测长期结局，直径≤10 毫米的瘘管效果最好。
