Innovative Endoscopic Management of Recurrent Gastrogastric Fistula Post-Roux-en-Y Gastric Bypass Patient Using Cardiac Septal Occluder and Lumen-Apposing Metal Stent

Gastrogastric fistula (GGF) is a rare complication of post-Roux-en-Y gastric bypass, often challenging to manage. This case report presents a 63-year-old patient with recurrent GGF and gastrojejunal stricture, refractory to prior endoscopic treatments. Using a minimally invasive approach with atrial septal defect closure device and a lumen-apposing metal stent, the fistula was successfully closed, and stricture relieved. The patient reported complete symptom resolution at follow-up. This innovative approach of combining a cardiac septal occluder and lumen-apposing metal stent for management of complex GGF cases offers a promising alternative to surgical interventions.