EFFICACY OF ENDOSCOPIC TREATMENT OF POST-SLEEVE GASTRECTOMY FISTULAS ACCORDING TO THE RADIOLOGICAL TYPE

Aims:

The originality of this 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 a CT scan with oral opacification: fistula without a communicating abscess (Type I), fistula with a communicating abscess (Type II), fistula with an abscessed sub- and sus-diaphragmatic communicating collection (Type III). Treatment algorithm consisted of the insertion of a naso-jejunal feeding tube (NJFT) for Type I fistulas and the placement of a NJFT with EID with or without surgical drainage depending on the septic status for type II and III fistulas.

Results:

Forty-nine patients were included. The clinical success rate of the procedure with fistula healing was 100% in the group I, 96% in the group II and 12% for group III (p = 0.001). Mean time for diagnosis of the fistula was significantly higher in type III compared to type I and type II (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 type 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 type I (13,3) and II (49) p = 0,001.

Conclusions:

This study shows that proper characterization of the type of fistula before the endoscopic treatment of post-sleeve fistulas could improve the efficacy of the endoscopic treatment.