SUCCESS OF DIFFERENT CLOSURE MODALITIES OF GASTRO-GASTRIC OR JEJUNAL-GASTRIC FISTULA CLOSURE AND NON-CLOSURE AFTER EDGI
Recommended Citation
Boortalary T, Tran T, McDonald N, Kahaleh M, Tyberg A, Shahid H, Sarkar A, Pawa R, Pawa S, Ventura F, Cohen E, Krafft M, Thakkar S, Singh S, Nasr J, Nimri F, Zuchelli T, Dang D, Piraka C, Hassan K, Sharaiha R, Kumar A, Schlachterman A, Kowalski T, Kamal F. SUCCESS OF DIFFERENT CLOSURE MODALITIES OF GASTRO-GASTRIC OR JEJUNAL-GASTRIC FISTULA CLOSURE AND NON-CLOSURE AFTER EDGI. Gastrointest Endosc 2024; 99(6):AB811-AB812.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
Gastrointest Endosc
Abstract
Introduction: EUS-directed transgastric intervention (EDGI) involves the creation of a temporary tract between gastric pouch or jejunum and excluded stomach in a Roux-en-Y gastric bypass (RYGB) patient by placing a lumen apposing metal stent (LAMS) into the excluded stomach. Once the intended intervention is completed, the LAMS is removed. The practices for closure of the resulting gastro-gastric or jejunal-gastric fistula vary widely. The purpose of this study was to investigate the efficacy of different closure modalities. Methods: This was a retrospective study across 6 different medical centers of patients who had undergone the EDGI procedure with subsequent LAMS removal. Patients who did not have a follow up study with either an upper GI series or repeat endoscopy to assess fistula closure were excluded. The Fisher’s exact, Chi-square and Mann-Whitney U Test were used when appropriate. Statistical analysis was performed using SPSS version 28 with p < 0.05 considered statistically significant. Results: A total of 106 patients were included. 22 patients (21%) had persistent fistulas on follow-up. Upper GI series or repeat endoscopy for assessing fistula closure were done within a median of 41.5 days post LAMS removal (IQR 24 -108). The modalities used for fistula closure are described in Table 1. Argon plasma coagulation (APC) combined with Overstitch was the most common modality used for fistula closure with a persistent fistula found in 8/45 patients (17.8%). By comparison, a persistent fistula was found in 4/16 patients (25%) whose fistulae were not closed. APC combined with through-the-scope (TTS) clips had a high success rate in closing fistulae with a persistent fistula in 1/17 patients (5.9%). 15 patients had 15mm LAMS, 90 had 20mm LAMS, and 1 unknown. The size of LAMS or location of LAMS placement (G-G vs J-G) was not significantly associated with incidence of persistent fistula with p values of 0.513 and 0.704 respectively. Patients with persistent fistulas had longer LAMS dwell times than those without fistulas; median of 100.5 days (IQR 40 -182.5), verses 30.5 days (IQR 22 -41.75) with P< 0.001. Conclusions: Success rates of different closure modalities vary in patients with post LAMS EDGI gastro-gastric or jejunal-gastric fistulas in RYGB patients. Long LAMS dwell times and no closure are associated with high rates of persistent fistulae. APC with Overstitch or APC with TTS clips were associated with lower rates of persistent fistula after closure. Based on the available data, minimizing LAMS dwell times and primary closure after LAMS removal should be considered in these patients.
Volume
99
Issue
6
First Page
AB811
Last Page
AB812
