RSS-Feed abonnieren
DOI: 10.1055/a-1422-2631
Long-term endoscopic follow-up after closure of a post-bariatric surgery fistula with a cardiac septal defect occluder
![](https://www.thieme-connect.de/media/endoscopy/202203/lookinside/thumbnails/2365_10-1055-a-1422-2631-1.jpg)
Bariatric surgery is currently the most effective treatment strategy for obesity; however, post-surgical fistulas may occur in up to 8.3 % of patients following traditional Roux-en-Y gastric bypass (RYGB) [1]. Currently endoscopic treatment of these complications remains challenging, with unsuccessful fistula closure occurring in 20 % of patients [1] [2]. More recently, the use of a cardiac septal defect occluder (CSDO) device has been proposed as a novel treatment for the closure of gastrointestinal fistulas. A CSDO is a double-disc self-expanding closure device made of nitinol and interwoven polyester. The successful use of CSDOs in the management of gastrointestinal surgical and bariatric leaks has been reported; however, there are limited data regarding long-term outcomes [3] [4]. In this video, we describe the successful closure of a gastrocutaneous fistula using a CSDO and demonstrate persistent closure at long-term follow-up ([Video 1]).
Video 1 Long-term follow-up of successful gastrocutaneous fistula closure using a cardiac septal defect occluder.
Qualität:
A 36-year-old man with a history of RYGB 3 years previously presented to our institution with a gastrocutaneous fistula. Initial treatment with a fully covered self-expandable metal stent (SEMS) was unsuccessful, and the patient subsequently underwent treatment with a CSDO [5]. The CSDO procedure was immediately successful with closure of the gastrocutaneous fistula and, at 1-year follow-up, endoscopy demonstrated an intact, well-positioned CSDO, with no evidence of a fistula ([Fig. 1 a]). At 3-year follow-up, routine endoscopy did not identify the CSDO ([Fig. 1 b]). An upper gastrointestinal contrast study was performed and confirmed that the CSDO was not present in the gastrointestinal lumen or intra-abdominal cavity ([Fig. 2]). Despite the presumed migration of the device, the fistula remained closed with no recurrent fistula or leakage noted.
![](https://www.thieme-connect.de/media/endoscopy/202203/thumbnails/10-1055-a-1422-2631-i2365ev1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202203/thumbnails/10-1055-a-1422-2631-i2365ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
In summary, the use of a CSDO device appears to be a safe and effective long-term treatment for patients with post-surgical gastrocutaneous fistulas. While more data are needed to verify these results, CSDOs may be a feasible alternative for gastrointestinal leaks and fistulas that are refractory to traditional endoscopic techniques.
Endoscopy_UCTN_Code_TTT_1AO_2AI
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos
Publikationsverlauf
Artikel online veröffentlicht:
16. April 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Okazaki O, Bernardo WM, Brunaldi VO. et al. Efficacy and safety of stents in the treatment of fistula after bariatric surgery: a systematic review and meta-analysis. Obes Surg 2018; 28: 1788-1796
- 2 de Moura DTH, Sachdev AH, Thompson CC. Endoscopic full-thickness defects and closure techniques. Curr Treat Options Gastroenterol 2018; 16: 386-405
- 3 Baptista A, de Moura DTH, Jirapinyo P. et al. Efficacy of the cardiac septal occluder in the treatment of post-bariatric surgery leaks and fistulas. Gastrointest Endosc 2019; 89: 671-679.e1
- 4 De Moura DTH, Baptista A, Jirapinyo P. et al. Role of cardiac septal occluders in the treatment of gastrointestinal fistulas: a systematic review. Clin Endosc 2020; 53: 37-48
- 5 de Moura DTH, Ribeiro IB, Funari MP. et al. Novel use of a cardiac septal occluder to treat a chronic recalcitrant bariatric fistula after Roux-en-Y gastric bypass. Endoscopy 2019; 51: E111-E112