ENDOSCOPIC TREATMENT OF GASTROBRONCHIAL FISTULA AFTER SLEEVE GASTRECTOMY WITH INJECTION OF CYANOACRYLATE GLUE (WITH VIDEO)

Aims Gastrobronchial fistula (GBF) is a rare complication of bariatric surgery. Traditionally, GBF is managed surgically with or without pulmonary lobectomy. Endoscopic management of GBF consists of occluding the fistula by clips or esophageal prosthesis or in rare case by injecting glue. The aim was to evaluate the effectiveness of endoscopic treatment of GBF by injection of cyanoacrylate.

Methods Retrospective monocentric study of consecutive cases of GBF after bariatric surgery referred for management. The endoscopic management consisted of two steps: first step consisted in treating the collection or abscess by internal drainage (double pig tail prothesis) and irrigation/washing of the cavity with a nasocavitary drain. Then, a second step consisted by gluing the GBF using an injection of cyanoacrylate and lipiodol into the fistula pathway in order to occlude it. The main outcome was the absence of GBF at 6 months on imaging and/or upper endoscopy with fluoroscopy opacification.

Results A total of 11 patients were treated for GBF after bariatric surgery between August 2009 and June 2019. All patients were women who had a laparotomy sleeve gastrectomy. The average age was 46.3 years (24-69). The development of GBF occurred, on average, within 10 months after sleeve gastrectomy. 8 patients were successfully treated without recurrence at 6 months (72%; 8/11) with disappearance of clinical signs. Of these, 4 patients received a single glue injection and 4 had up to three sessions of gluing before the fistula was completely occluded. Three patients were treated surgically after failure of endoscopic GBF gluing.

Conclusions Cyanoacrylate injection seems to be a simple and promising technique in the treatment of GBF after sleeve gastrectomy. In case of success, it allows to avoid a surgical conversion to By-pass associated or not with a pulmonary lobectomy.