Endoscopic closure versus surgical revision in the management of gastrogastric fistula after Roux-en-Y gastric bypass

Background: Gastrogastric fistulas (GGFs) occur in 1.3% to 6% of Roux-en-Y gastric bypass (RYGB) patients and can be associated with abdominal pain, reflux, weight regain, and onset of diabetes. Endoscopic and surgical treatments are available without prior comparisons. The aim of this study was to compare endoscopic and surgical treatment methods in RYGB patients with GGF. Methods: In a retrospective matched cohort study of RYGB patients who underwent endoscopic closure (ENDO) or surgical revision (SURG) for GGF, 1:1 matching was performed based on age, sex, body mass index, and weight regain. Patient demographics, GGF size, procedural details, symptoms, and treatment-related adverse events were collected. A comparison of symptom improvement and treatment-related adverse event rates was performed. Fisher exact test, Student t test, and Wilcoxon rank-sum test were performed. Results: Ninety RYGB patients with GGF (45 ENDO, 45 matched SURG) were included. GGF symptoms included weight regain (80%), GERD (71%), and abdominal pain (67%). At 6 months, the ENDO and SURG groups experienced 0.59% and 5.5% total weight loss (TWL) (P = .0002). At 12 months, the ENDO and SURG groups experienced 1.9% and 6.2% TWL (P = .007). Abdominal pain improved in 12 (52.2%) ENDO and 5 (15.2%) SURG patients at 12 months (P = .007). Diabetes and reflux resolution rates were similar between groups. Treatment-related adverse events occurred in 4 (8.9%) ENDO and 16 (35.6%) SURG patients (P = .005), of which 0 and 8 (17.8%), respectively, were serious (P = .006). Conclusion: Endoscopic GGF treatment produces greater improvement in abdominal pain and fewer overall and serious treatment-related adverse events. However, surgical revision appears to yield greater weight loss.