Novel Endoscopic Management of a Chronic Gastro-Gastric Fistula Using a Cardiac Septal Defect Occluder
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MULTIMEDIA ARTICLE
Novel Endoscopic Management of a Chronic Gastro-Gastric Fistula Using a Cardiac Septal Defect Occluder Diogo Turiani Hourneaux de Moura 1,2 & Alberto Machado da Ponte-Neto 1 & Kelly E. Hathorn 2 & Epifânio Silvino do Monte Junior 1 & Alberto Baptista 3 & Igor Braga Ribeiro 1 & Christopher C. Thompson 2 & Eduardo Guimarães Hourneaux De Moura 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Closure of GG fistulas after RYGB is challenging due to epithelialization of the tract. Common endoscopic therapies are less efficacious than surgical revision, which is unfortunately fraught with high morbidity and mortality. Cardiac septal defect occluders (CSDO) have been successfully used for the management of gastrointestinal fistulas, but use has never been reported in management of GG fistulas. Thus, we describe the first off-label use of CSDO for the treatment of a GG fistula. Materials and Methods Endoscopy and fluoroscopic examination determined the appropriate size of CSDO for closure. A guidewire was placed in the remnant stomach followed by placement of the delivery system. Then, under fluoroscopy, we deployed the first flange of the CSDO in the remnant stomach. Then, under fluoroscopy and endoscopic visualization, the second flange is deployed in the gastric pouch. Results A 51-year-old woman, status-post RYGB in 2008, presented with a 6-month history of weight regain and reflux. She had regained weight to 84 kg (BMI = 32 kg/m2) when she was found to have a GG fistula. She underwent successful CSDO placement and, 3 months later, had lost 10 kg with significant improvement in her reflux. Repeat evaluation confirmed successful fistula closure. Conclusion The use of CSDO was technically feasible and appeared to be effective and safe. Future studies should continue to investigate the role of CSDO in management of this challenging condition. Keywords Obesity . Bariatric . Fistula . GERD . Endoscopy . Surgery
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04616-y) contains supplementary material, which is available to authorized users. * Diogo Turiani Hourneaux de Moura [email protected]
Christopher C. Thompson [email protected]
Alberto Machado da Ponte-Neto [email protected] Kelly E. Hathorn [email protected]
Eduardo Guimarães Hourneaux De Moura [email protected] 1
Gastrointestinal Endoscopy Unit, Gastrointestinal Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – HC/FMUSP, Rua Enéas de Carvalho Aguiar, 255, São Paulo, SP 05679-065, Brazil
Alberto Baptista [email protected]
2
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Igor Braga Ribeiro [email protected]
3
Hospital das Clínicas de Caracas, Caracas, Venezuela
Epifânio Silvino do Monte Junior [email protected]
OBES SURG
Purpose Gastro-gastric (GG) fistula is a commu
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