Department of Visceral and Bariatric Surgery, Hirslanden Clinic Beau-Site, Schaenzlihalde 1, CH-3013, Berne, Switzerland.
Obes Surg. 2019 Jan;29(1):23-27. doi: 10.1007/s11695-018-3488-1.
Gastro-gastric fistulas (GGF) are reported to be as high as 12% after gastric bypass for treatment of morbid obesity. While different endoscopic methods are described, the management traditionally consists of surgical revision with high associated morbidity. The aim of the study was to assess feasibility, safety and success rate of endoscopic closure using an endoscopic suturing device.
From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing endoscopic closure of a GGF with the Apollo Overstitch system (Apollo Endosurgery, Austin, Texas, USA). Demographic details, procedure details, and outcome variables were recorded.
A total of six patients (M:F = 5:1) underwent endoscopic fistula closure. Five patients (83.3%) had a prior banded gastric bypass (with subsequent band removal). The median number of prior abdominal surgeries was 3, the mean time from bypass to endoscopic fistula closure was 5 years (range 1.1-10.4). While immediate complete endoscopic fistula closure was possible in 10 of 12 attempts in those six patients (83%), all patients had recurrent (persistent) fistulas at follow-up. After a mean follow-up time of 12 months, 83.3% had further laparoscopic converted to open (n = 2) or laparoscopic (n = 3) revisions with complete fistula closure. One patient is refusing further intervention.
Endoscopic gastro-gastric fistula closure with an endoscopic suturing device is feasible and safe. Unfortunately, due to the nature of gastro-gastric fistulas, permanent successful closure is rare. Therefore, the approach should be reserved for patients in whom a laparoscopic or open surgical attempt is impossible due to prior abdominal revisions.
胃旁路手术后胃-胃瘘（GGF）的发生率高达 12%，用于治疗病态肥胖。虽然有不同的内镜方法描述，但传统上的治疗方法是通过手术修复，但与高发病率相关。本研究的目的是评估使用内镜缝合装置进行内镜闭合的可行性、安全性和成功率。
从 2016 年 1 月至 2018 年 3 月，我们回顾了所有使用 Apollo 过缝系统（Apollo Endosurgery，Austin，Texas，USA）内镜闭合 GGF 的患者的电子病历。记录了人口统计学细节、手术细节和结果变量。
共有 6 名患者（男：女=5：1）接受了内镜瘘口闭合术。5 例（83.3%）患者行带蒂胃旁路术（随后取出带蒂）。中位数既往腹部手术次数为 3 次，从旁路到内镜瘘口闭合的平均时间为 5 年（范围 1.1-10.4）。在这 6 名患者的 12 次尝试中，有 10 次（83%）立即完全内镜瘘口闭合，但所有患者在随访时均有复发性（持续性）瘘。在平均 12 个月的随访后，83.3%的患者进一步行腹腔镜转为开腹（n=2）或腹腔镜（n=3）修复，完全闭合瘘口。1 例患者拒绝进一步干预。
使用内镜缝合装置内镜胃-胃瘘闭合是可行和安全的。不幸的是，由于胃-胃瘘的性质，永久性成功闭合很少见。因此，该方法应保留给因既往腹部手术而无法进行腹腔镜或开腹手术尝试的患者。
