Chopra Preeyati, Ohri Ashwariya, Goyal Mayank, Buttar Navtej S
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
VideoGIE. 2025 Feb 21;10(7):355-357. doi: 10.1016/j.vgie.2025.02.007. eCollection 2025 Jul.
Gastrogastric fistula (GGF) is a known rare adverse event after gastric bypass surgery. Management of refractory GGF, either surgical or endoscopic, is associated with poor long-term results. There is limited evidence on the successful management of refractory GGF with endoscopy.
A 62-year-old female patient status post Roux-en-Y gastric bypass presented with symptoms of aspiration. She not was responsive to repeated endoscopic and laparoscopic methods for fistula closure, which made her unfit for surgical intervention. We decided to proceed with an endoscopic attempt for fistula management. On EGD, a 15-mm fistula between the gastric pouch and the remnant stomach was seen. A 24F PEG tube bumper with a 25-mm diameter was folded with a grasping device and inserted in the 15-mm fistula, such that the bumper fully covered the fistula. The bumper was sutured to the surrounding mucosa in a purse string fashion. The open tip of the PEG tube was driven into the Roux limb and sutured in the jejunum to prevent migration of the tube. This achieved the dual purpose of closing the site of the fistula with the PEG bumper while securing a draining tube to prevent aspiration of the bile reflux in the gastric pouch.
A postprocedure fluoroscopy demonstrated no evidence of a fistula. At follow-up, the patient reported no reflux and complete resolution of symptoms. The patient is planned for a yearly replacement of the PEG tube, given multiple comorbidities and a hostile abdomen due to previous procedures that make her unfit for surgical intervention.
In a patient who did not respond to repeated endoscopic and laparoscopic methods for management, we describe a novel endoscopic technique for management of refractory GGF using a PEG tube serving the dual purpose of plug and drain after Roux-en-Y gastric bypass surgery.
胃胃瘘（GGF）是胃旁路手术后一种已知的罕见不良事件。难治性GGF的治疗，无论是手术治疗还是内镜治疗，长期效果都不佳。关于内镜成功治疗难治性GGF的证据有限。
一名62岁女性患者，在接受Roux-en-Y胃旁路手术后出现误吸症状。她对反复的内镜和腹腔镜瘘管闭合方法均无反应，这使得她不适合进行手术干预。我们决定尝试内镜治疗瘘管。在进行上消化道内镜检查（EGD）时，发现胃囊与残胃之间有一个15毫米的瘘管。将一个直径25毫米的24F经皮内镜下胃造瘘（PEG）管缓冲器用抓取装置折叠后插入15毫米的瘘管中，使缓冲器完全覆盖瘘管。以荷包缝合的方式将缓冲器缝合到周围黏膜上。将PEG管的开口端插入空肠袢并缝合在空肠内，以防止管子移位。这样就实现了双重目的，即用PEG缓冲器封闭瘘管部位，同时固定一根引流管以防止胃囊内胆汁反流引起误吸。
术后荧光透视检查未发现瘘管迹象。随访时，患者报告无反流，症状完全缓解。鉴于患者有多种合并症且因既往手术导致腹部粘连严重，不适合手术干预，计划每年更换PEG管。
对于对反复的内镜和腹腔镜治疗方法均无反应的患者，我们描述了一种新的内镜技术，用于在Roux-en-Y胃旁路手术后治疗难治性GGF，使用PEG管实现封堵和引流的双重目的。
