Closure of a Nonhealing Gastrocutaneous Fistula Using Argon Plasma Coagulation and Endoscopic Hemoclips

Hameed, Hassan; Kalim, Sahir; Khan, YI

doi:10.1155/2009/973206

Cited by 30 publications

(15 citation statements)

References 11 publications

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“…Therefore, our decision to combine the endoscopic closure procedure with surgical de-epithelialisation may have contributed to the successful outcome. Other non-surgical options for de-epithelialisation in the literature have included electro and chemical cautery, argon beam photocoagulation and biopsy removal6 7 10 13 15; these could potentially be used in conjunction with the Padlock clip as an alternative to surgical excision.…”

Section: Discussionmentioning

confidence: 99%

“…Successful outcomes have been reported for GCF with endoscopic clip closure6–12 and endoscopically assisted suturing techniques 13–15. A combined approach to de-epithelialise the tract in addition to mechanical endoscopic closure has been advocated in the majority of published cases,6 7 10 13 15 thereby mimicking the surgical approach, with good results, albeit limited to small series and case reports. Given that endoscopic clip closure is less invasive than endoscopically assisted suturing, it is often the first-line approach.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic closure of a refractory gastrocutaneous fistula using a novel over-the-scope Padlock clip following de-epithelialisation of the fistula tract

et al. 2015

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Persistent gastrocutaneous fistula (GCF) is a difficult to manage complication following gastrostomy tube removal, with leakage resulting in distressing sequelae including cutaneous injury, infection and dehydration. Many such patients are high-risk for invasive surgery and, to date, endoscopic closure techniques, including clipping systems, have limitations. We present the case of a 62-year-old woman with persistently leaking GCF 6 months postgastrostomy tube removal, despite maximal antisecretory therapy and postpyloric feeding, and describe failed attempted endoscopic closure with conventional clips. Treatment options were discussed and informed consent was given for an attempt at endoscopic closure using a novel radial closure device ('Padlock clip') combined with surgical de-epithelialisation, with the understanding that this device has never previously been used in this setting. At follow-up 2 weeks postprocedure, the patient was asymptomatic with complete healing of the GCF. This approach has advantages over other endoscopic closure techniques and can be considered as an alternative approach to GCF closure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic closure of a refractory gastrocutaneous fistula using a novel over-the-scope Padlock clip following de-epithelialisation of the fistula tract

et al. 2015

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“…Risk factors for persistent fistulas after gastrostomy removals include usual factors that would perpetuate a fistula such as infection at the site, a short, wide tract in a thin person with little distance between the stomach and skin, and a very long-standing gastrostomy tube. [81][82][83] Janik et al found that a gastrostomy tube duration longer than 8 months was associated with a persistent fistula in their pediatric population. 81 If a gastrocutaneous fistula is persisting, then initial measures include using chemical cautery with silver nitrate sticks and placing the patient on twice daily proton pump inhibitors and possible prokinetic agents as well.…”

Section: Gastrocutaneous Fistula After Removalmentioning

confidence: 99%

Endoscopic Feeding Access

McCormack

Tariq

2018

Dig Dis Interv

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The need for enteral access for nutritional support has become increasingly important. It is estimated up to a third of hospitalized patients will suffer from malnourishment. There is evidence that enteral is preferable over parenteral nutrition for improved outcomes. Various approaches for enteral access exist today including blind placement of enteral catheters, radiographically, and surgically placed catheters. However, the endoscopic approach for enteral access is a well-established, reliable, safe, and quick method of obtaining enteral access. In this review article, we will cover the various endoscopic approaches for enteral access. We believe there is no single best approach for enteral access and that it should be tailored to the individual patient. This article will cover both temporary options such as nasoenteric catheters and more permanent options such as percutaneous endoscopic stomas (gastrostomy, gastrojejunostomy, direct jejunostomy) and describe their techniques, indications, contraindications, and pitfalls. Additionally, with the rise of weight loss surgery, we will cover how to manage the patient with altered gastrointestinal anatomy. Lastly, we will also review difficult post procedure scenarios associated with all of these endoscopic methods for enteral access and how to either prevent or properly manage them.

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“…Minimally invasive techniques, including gastric mucosa endoclipping, fibrin glue, and fistula tract lining disruption using a curette or electrocautery device, have also been described and may be attempted prior to proceeding with surgery. [75][76][77][78] Anecdotally, placing a purse-string suture beneath the skin in the subcutaneous tissue may be added to the endoclipping of the mucosal defect to promote closure.…”

Section: Persistent Fistula Following Removalmentioning

confidence: 99%

A Tutorial on Enteral Access in Adult Patients in the Hospitalized Setting

Miller

McClave

Király

et al. 2014

J Parenter Enteral Nutr

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Enteral access is a cornerstone in the provision of nutrition support. Early and adequate enteral support has consistently demonstrated improved patient outcomes throughout a wide range of illness. In patients unable to tolerate oral intake, multiple options of delivery are available to the clinician. Access requires a multidisciplinary effort that involves nurses, dietitians, and physicians to be successful. These techniques and procedures are not without morbidity and even mortality. A comprehensive understanding of the appropriate management of these tubes and their inherent complications should be garnered by all those involved with nutrition support teams. This tutorial reviews available options for enteral access in addition to commonly encountered complications and their management.

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Closure of a Nonhealing Gastrocutaneous Fistula Using Argon Plasma Coagulation and Endoscopic Hemoclips

Cited by 30 publications

References 11 publications

Endoscopic closure of a refractory gastrocutaneous fistula using a novel over-the-scope Padlock clip following de-epithelialisation of the fistula tract

Endoscopic closure of a refractory gastrocutaneous fistula using a novel over-the-scope Padlock clip following de-epithelialisation of the fistula tract

Endoscopic Feeding Access

A Tutorial on Enteral Access in Adult Patients in the Hospitalized Setting

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