Management of gastro-gastric fistula after Roux-en-Y gastric bypass: a systematic review and meta-analysis of endoscopic versus surgical outcomes
In brief
Surgery reported 100% success, while endoscopy durably closed 30% of fistulas
In pooled observational studies of gastro-gastric fistula after gastric bypass, endoscopy achieved durable closure in about 3 in 10 patients, with major adverse events in 1.6%; surgical revision had 100% clinical success but complications in 26.2%. These results suggest a trade-off between durability and safety, not definitive superiority, because the evidence came from just nine studies.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 27 August 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Maryam Hassanesfahani, Dominique Popescu, Mrinalini Alla, Nageswara Mandava, Noman Khan, Darshak Shah
- PMID
- 42786010
- DOI
- 10.1016/j.soard.2026.08.016
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 26 September 2026): Systematic review of endoscopic vs surgical outcomes
Abstract
Gastro-gastric fistula is an uncommon but clinically significant complication after Roux-en-Y gastric bypass, presenting with weight regain, epigastric pain, bile reflux, or recurrent marginal ulceration. Although multiple endoscopic and surgical techniques have been described, comparative outcome data remain limited. We conducted a systematic review and meta-analysis of studies published between 1990 and 2025 evaluating endoscopic and surgical management of gastro-gastric fistula. Seventy-six studies underwent full-text assessment for eligibility, and 9 studies were eligible for quantitative analysis (5 endoscopic series, n = 127; 4 surgical series, n = 65). Endoscopic therapy achieved durable fistula closure in 29.9% of patients, with a low major adverse event rate (1.6%). Surgical revision demonstrated 100% clinical success, with a 26.2% postoperative complication rate and no procedure-related mortality. Random-effects modeling yielded consistent pooled estimates with low statistical heterogeneity. These findings suggest that endoscopic management offers an excellent safety profile but limited long-term durability, whereas surgical revision was associated with higher rates of durable fistula closure at the cost of higher perioperative morbidity. Given the observational nature of the available evidence, these findings should be interpreted cautiously and should not be considered evidence of definitive treatment superiority. Treatment selection should, therefore, be guided by fistula characteristics, chronicity, and patient risk profile. Standardized reporting and prospective evaluation of emerging endoscopic and hybrid techniques are needed to optimize management strategies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.