Efficacy of Endoscopic Treatment of Post-Sleeve Gastrectomy Fistulas According to the Radiological Type
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Background and Aims
The originality of this retrospective study relies on the evaluation of the effectiveness of the endoscopic internal drainage (EID) according to the type of fistula.
The type of fistula was classified initially according to a CT scan with oral opacification: fistula without a communicating abscess (type I), fistula with a communicating abscess (type II), and fistula with an abscessed sub- and sus-diaphragmatic communicating collection (type III). Treatment algorithm consisted of the insertion of a nasojejunal feeding tube (NJFT) for type I fistulas and the placement of a NJFT with EID with or without surgical drainage for types II and III.
Forty-nine patients were included. The clinical success rate with fistula healing was 100% in group I, 96% in group II, and 12% for group III (p = 0.001). Mean time for diagnosis of the fistula was significantly higher in type III (p = 0.04). The mean estimated size of the defect was higher in type II, 11.2 mm and III, 10 mm versus type I, 2.8 mm (p = 0.001). The average number of scheduled endoscopic sessions were 2, 2.7, and 5.2 for types I, II, and III, respectively (p = 0.001). The number of unscheduled reinterventions was also significantly higher in type III (p = 0.03). The NJFT was left in place for a significantly longer duration in type III (136 days) compared to types I (3, 13) and II (49) p = 0.001.
This study shows that proper characterization of the type of fistula before the endoscopic treatment of post-sleeve fistulas improves the efficacy of the endoscopic treatment.
KeywordsSleeve gastrectomy Fistulas Endoscopy
A. Sportes: Design of the protocol, performance of endoscopic treatment, inclusion of patients, collection of data, preparation of the manuscript
G. Aireini: Performance of endoscopic treatment, inclusion of patients, collection of data
R. Kamel: Preparation of the manuscript
C. Pratico: Performance of endoscopic treatment
JJ. Raynaud: Inclusion of patients, collection of data
JM. Sabate: Revision of the manuscript, statistical analysis
G. Donatelli: Performance of endoscopic treatment, revision of the manuscript
R. Benamouzig: Design of the protocol, revision of the manuscript
Compliance with Ethical Standards
This retrospective study was approved by the local ethics committee of the Assistance Publique des Hôpitaux de Paris.
Conflict of Interest
The authors declare that they have no conflicts of interest.
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