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Efficacy of Endoscopic Treatment of Post-Sleeve Gastrectomy Fistulas According to the Radiological Type

  • A. SportesEmail author
  • G. Aireini
  • R. Kamel
  • C. Pratico
  • J. J. Raynaud
  • J. M. Sabate
  • G. Donatelli
  • R. Benamouzig
Original Contributions
  • 33 Downloads

Abstract

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Sleeve gastrectomy Fistulas Endoscopy 

Notes

Authors’ Contributions

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Gastroenterology UnitHôpital Avicenne (AP-HP)BobignyFrance
  2. 2.Institut Arnault TZANCK Gastroenterology UnitSaint-Laurent-du-VarFrance
  3. 3.Endoscopy UnitHôpital privé des PeupliersParisFrance

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