A Sportes1,2, G Aireini3, R Kamel3, C Pratico3, J J Raynaud3, J M Sabate3, G Donatelli3,4, R Benamouzig3. 1. Gastroenterology Unit, Hôpital Avicenne (AP-HP), 125 Rue de Stalingrad, 93000, Bobigny, France. adrien.sportes@free.fr. 2. Institut Arnault TZANCK Gastroenterology Unit, 231 Avenue Maurice Donat, 067000, Saint-Laurent-du-Var, France. adrien.sportes@free.fr. 3. Gastroenterology Unit, Hôpital Avicenne (AP-HP), 125 Rue de Stalingrad, 93000, Bobigny, France. 4. Endoscopy Unit, Hôpital privé des Peupliers, 24 Rue des Peupliers, 75013, Paris, France.
Abstract
BACKGROUND AND AIMS: The originality of this retrospective 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 to a CT scan with oral opacification: fistula without a communicating abscess (type I), fistula with a communicating abscess (type II), and fistula with an abscessed sub- and sus-diaphragmatic communicating collection (type III). Treatment algorithm consisted of the insertion of a nasojejunal feeding tube (NJFT) for type I fistulas and the placement of a NJFT with EID with or without surgical drainage for types II and III. RESULTS: Forty-nine patients were included. The clinical success rate with fistula healing was 100% in group I, 96% in group II, and 12% for group III (p = 0.001). Mean time for diagnosis of the fistula was significantly higher in type III (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 types 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 types I (3, 13) and II (49) p = 0.001. CONCLUSION: This study shows that proper characterization of the type of fistula before the endoscopic treatment of post-sleeve fistulas improves the efficacy of the endoscopic treatment.
BACKGROUND AND AIMS: The originality of this retrospective 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 to a CT scan with oral opacification: fistula without a communicating abscess (type I), fistula with a communicating abscess (type II), and fistula with an abscessed sub- and sus-diaphragmatic communicating collection (type III). Treatment algorithm consisted of the insertion of a nasojejunal feeding tube (NJFT) for type I fistulas and the placement of a NJFT with EID with or without surgical drainage for types II and III. RESULTS: Forty-nine patients were included. The clinical success rate with fistula healing was 100% in group I, 96% in group II, and 12% for group III (p = 0.001). Mean time for diagnosis of the fistula was significantly higher in type III (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 types 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 types I (3, 13) and II (49) p = 0.001. CONCLUSION: This study shows that proper characterization of the type of fistula before the endoscopic treatment of post-sleeve fistulas improves the efficacy of the endoscopic treatment.
Authors: Ossamu Okazaki; Wanderley M Bernardo; Vitor O Brunaldi; Cesar C de Clemente Junior; Maurício K Minata; Diogo T H de Moura; Thiago F de Souza; Josemberg Marins Campos; Marco Aurélio Santo; Eduardo G H de Moura Journal: Obes Surg Date: 2018-06 Impact factor: 4.129
Authors: G Donatelli; J-L Dumont; F Cereatti; S Ferretti; B M Vergeau; T Tuszynski; G Pourcher; H Tranchart; P Mariani; A Meduri; J-M Catheline; I Dagher; F Fiocca; J-P Marmuse; B Meduri Journal: Obes Surg Date: 2015-07 Impact factor: 4.129
Authors: Elizabeth R Berger; Ronald H Clements; John M Morton; Kristopher M Huffman; Bruce M Wolfe; Ninh T Nguyen; Clifford Y Ko; Matthew M Hutter Journal: Ann Surg Date: 2016-09 Impact factor: 12.969
Authors: Alberto Murino; Marianna Arvanitakis; Olivier Le Moine; Daniel Blero; Jacques Devière; Pierre Eisendrath Journal: Obes Surg Date: 2015-09 Impact factor: 4.129