Diagnostic Gastro-Duodenoscopy Via A Gastro-Gastric Fistula Prior To Overstitch Closure

Roux-en-Y gastric bypass (RYGB) remains the gold standard surgical treatment for obesity.
Most surgeons are aware of the challenge posed by the altered anatomy on the endoscopic evaluation and treatment of foregut pathology (gastric and duodenal ulcers). Gastro-gastric (GG) fistulae complicate as many as 1,2-12% of RYGB. Endoscopic therapies for GG fistulae closure are well described , although the long term success rate for closure is low. In this video, we describe the successful endoscopic and fluoroscopic evaluation of the bypassed foregut in a RYGB patient using an ultra slim endoscope to traverse a 3mm GG fistula prior to endoscopic closure with the Overstitch TM suturing system (Apollo Endosurgery, Austin, TX). Clinical history: 58-year-old female remote from standard RYGB; new symptoms of nausea, epigastric discomfort. Video by Eric M Pauli, MD.