Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment.

Gastrogastric fistula (GGF) formation is an uncommon but well-recognized complication following Roux-en-Y gastric bypass for morbid obesity. Patients with GGF may be asymptomatic or have nonspecific problems of abdominal pain, weight regain, or ulcer formation at the gastrojejunal anastomosis. Maintaining a high index of suspicion is the key to diagnosis. Flexible upper endoscopy and upper gastrointestinal fluoroscopy are complementary imaging modalities for securing the diagnosis of GGF. Surgical repair of GGF is generally the most definitive management but is invasive and has the potential for morbidity. Endoscopic methods of closure have gained favor in recent years due to their noninvasive nature despite the lack of long-term data regarding their success. Novel methods of endoscopic closure, including endoscopic suturing, more closely resemble the surgical paradigm and will likely supplant traditional surgical methods for the management of GGF.