Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection

  • Paraskevas Gkolfakis (Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Universite Libre de Bruxelles) ;
  • Marc-Andre Bureau (Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Universite Libre de Bruxelles) ;
  • Marianna Arvanitakis (Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Universite Libre de Bruxelles) ;
  • Jacques Deviere (Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Universite Libre de Bruxelles) ;
  • Daniel Blero (Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Universite Libre de Bruxelles)
  • Received : 2020.12.26
  • Accepted : 2021.02.09
  • Published : 2022.01.30
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Abstract

A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient's symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

Keywords

Acknowledgement

We would like to acknowledge the contribution of a medical writer, Sandy Field, PhD, for English language editing and formatting of this manuscript.

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