P3755 - Gastro-gastric Fistula Creation to Treat Short Bowel Syndrome in a Gastric Bypass Patient

Fatma Ozguc, DO¹, Maggie Beard, ², Mason Adams, MD², Shreyas Saligram, MD², Sushreyta Rose, DO^2
1UTHSCSA, San Antonio, TX; ²University of Texas Health Science Center at San Antonio, San Antonio, TX

Introduction: A gastro-gastric fistula is a communication between the proximal gastric pouch and the distal gastric remnant. It is usually reported as a chronic complication of gastric bypass that classically presents as epigastric pain with nausea and weight gain within three years of surgery1. Surgical management is often required. Here we present a unique case where a gastro-gastric fistula was purposefully created in a gastric bypass patient for short gut syndrome after a right hemicolectomy.

Case Description/Methods: 65-year-old female with past medical history of gastric bypass surgery for weight loss in 2005 then revision in 2011, right hemicolectomy in 2020 after bowel obstruction causing short gut syndrome, presented to the emergency department after her primary care doctor referred her for a potassium of 1.9. She underwent endoscopic ultrasound-guided placement of insert size Axios stent to create a gastro-gastric fistula to treat short gut syndrome. A CT scan with gastrointestinal contrast ruled out leakage after the procedure and there were no other post-procedural complications. The patient was discharged with close gastroenterology follow-up.

Discussion: Short bowel syndrome (SBS) is the reduction of gut function below the minimum necessary for the absorption of macronutrients, water, and electrolytes. Malnutrition and electrolyte abnormalities are the main complications of SBS2. The main causes of SBS include mesenteric infarction, surgical complications, Crohn's disease, volvulus, and trauma. The risk of developing complications in SBS is related to the remaining small intestine length and “restoring digestive continuity in order to optimize the digestive circuit” should be the initial treatment consideration2. Surgical lengthening of the small intestine or creation of a segmental reversal of small bowel are some maneuvers to restore digestive continuity in SBS. Gastro-gastric fistula creation in a gastric bypass patient who developed SBS allows lengthening and hence slowing of the gastrointestinal transit and may contribute to improvement of symptoms. This is a case of endoscopic manipulation of previous gastric bypass surgery to treat SBS.






1Nguyen J, Siksik JM, Genser L. Gastro-gastric fistula after gastric bypass. J Visc Surg. 2018 Oct;155(5):431-432. doi: 10.1016/j.jviscsurg.2018.07.008




2Billiauws L, Maggiori L, Joly F, Panis Y. Medical and surgical management of short bowel syndrome. J Visc Surg. 2018 Sep;155(4):283-291


Disclosures:


Fatma Ozguc, DO¹, Maggie Beard, ², Mason Adams, MD², Shreyas Saligram, MD², Sushreyta Rose, DO². P3755 - Gastro-gastric Fistula Creation to Treat Short Bowel Syndrome in a Gastric Bypass Patient, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.