Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention

Gastrobronchial fistula (GBF) is a serious complication following bariatric surgery, whose treatment by thoracotomy and/or laparotomy involves a high morbidity rate. We present the outcomes of endoscopic management for GBF as a helpful technique for its healing process. This is a multicenter retrospective study of 15 patients who underwent gastric bypass (n?=?10) and sleeve gastrectomy (n?=?5) and presented GBF postoperatively (mean of 6.7 months). Ten patients developed lung abscess and were treated by antibiotic therapy (n?=?10) and thoracotomy (n?=?3). Abdominal reoperation was performed in nine patients for abscess drainage (n?=?9) and/or ring removal (n?=?4) and/or nutritional access (n?=?6). The source of the GBF was at the angle of His (n?=?14). Furthermore, 14 patients presented a narrowing of the gastric pouch treated by 20 or 30 mm aggressive balloon dilation (n?=?11), stricturotomy or septoplasty (n?=?10) and/or stent (n?=?7). Fibrin glue was used in one patient. We performed, on average, 4.5 endoscopic sessions per patient. Endotherapy led to a 93.3% (14 out of 15) success rate in GBF closure with an average healing time of 4.4 months (range, 1–10 months), being shorter in the stent group (2.5?×?9.5 months). There was no recurrence during the average 27.3-month follow-up. A patient persisted with GBF, despite the fibrin glue application, and decided to discontinue it. GBF is a highly morbid complication, which usually arises late in the postoperative period. Endotherapy through different strategies is a highly effective therapeutic option and should be implemented early in order to shorten leakage healing time.