“Gastrogastric fistula (GGF) was a well-described complication after nondivided Roux-en-Y gastric bypass (RYGB), with a documented rate of up to 50%. Gastric transection with isolation of the gastric pouch (divided RYGB) reduces but does not eliminate this complication, which still occurs with a reported incidence ranging from 0% to 6%. Weight regain, epigastric pain, and marginal ulcer (MU) are the most common symptoms. Some GGF can be managed conservatively or by endoscopic approach, but surgery remains the standard of care.”

“Gastrogastric fistula is a rare complication after divided RYGB. Weight regain and epigastric pain with or without marginal ulcer are the most common presenting symptoms.
Diagnosis can be challenging, but combining UGI endoscopy and contrast study is the best method to confirm the diagnosis. Surgical treatment should be tailored to both location of the GGF and status of the gastrojejunostomy, but anastomotic revision is associated with higher complication rates. GGF classification, based on its anatomic location, could serve as a working basis to compare different surgical approaches.”

Ribeiro-Parenti, Lara et al. “Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass.” Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery vol. 13,2 (2017): 243-248.