Closure of non-healing gastrocutaneous fistula after percutaneous endoscopic gastrostomy by endoscopic submucosal dissection and over-the-scope clip

Gay-Chevallier, Servane; Lupu, Alexandru; Rivory, Jérôme; Rostain, Florian; Ponchon, Thierry; Saurin, Jean‐Christophe; Pioche, Mathieu

doi:10.1055/a-0858-9796

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…Induration and epithelialization of the tract are well known to diminish fistula healing [16]. Various attempts for de-epithelialization to promote fistula healing, such as surgical excision [16], argon plasma coagulation [17], and endoscopic submucosal dissection [18], have been reported. Conversely, it has been reported that thermal injury and mechanical trauma to the fistula may not contribute to OTSC use due to its transmural closure effects [11].…”

Section: Discussionmentioning

confidence: 99%

Over-the-Scope Clip Closure of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Tube Removal: A Report of Two Cases

Masaki

Yamada

2021

Cureus

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Persistent gastrocutaneous fistulas have conventionally been treated surgically. Over-the-scope clip (OTSC) was developed as an endoscopic closure device for full-thickness gastrointestinal defects and has become one of the treatment options for gastrocutaneous fistula. Herein, we report two cases of gastrocutaneous fistulas treated using OTSC. Case 1 was a 71-year-old woman and case 2 was an 88-year-old man, both of whom had severe frailty and had a persistent gastrocutaneous fistula after removal of the percutaneous endoscopic gastrostomy (PEG) tube. OTSC closure was chosen over surgical closure to reduce invasiveness. In case 1, OTSC was deployed using a suction method, which was technically successful. However, the fistula reopened two days later, indicating clinical failure of the OTSC. The cause of the failure may be due to an inadequate suction of the fistula into the applicator cap. Based on the experience of OTSC failure in case 1, OTSC in case 2 was deployed using the Anchor to pull the fistula into the cap more reliably. Fistula did not recur during the 30-month follow-up, indicating the clinical success of OTSC in case 2. The use of Anchor may increase the success rate of OTSC, but there is a dilemma that the use of Anchor increases cost. In summary, OTSC has the advantage of being less invasive compared to conventional surgery; however, the application of OTSC for chronic fistulas remains challenging due to issues regarding clinical success rate and cost.

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Section: Discussionmentioning

confidence: 99%

Over-the-Scope Clip Closure of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Tube Removal: A Report of Two Cases

Masaki

Yamada

2021

Cureus

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“…62 Once diagnosed, endoscopic approach, using endo clips to close the fistula is first choice, if it fails, surgery is necessary. 63…”

Section: Fistula Formationmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy

Liu

Yang

et al. 2021

Int J Gastrointest Interv

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Percutaneous endoscopic gastrostomy (PEG) is a feasible and safe technique for patients who need long-term feeding and cannot eat orally. With the increasing maturity of PEG technique, a large number of patients receive PEG tube placement every year in the world. However, PEG tube placement is not necessary in some patients, and some other patients are not evaluated strictly, leading to serious complications. In a broad sense, the mainly two indications for PEG include long-term enteral nutrition and gastric decompression. On the other hand, the main contraindications of PEG are distal intestinal obstruction, severe coagulation abnormalities, and severe infection at the PEG site. In the first section of this review, the indications and contraindications of PEG are introduced. Although PEG tube placement is a relatively safe technique, it can still cause a number of complications, including minor and major complications. Through standard management and treatment, the outcome of most patients is very good. In the second section of this review, we describe a variety of minor and major tube-related complications, and the treatment and prevention of these complications. In addition, the preparation and post-insertion care are also very important for PEG, which can reduce the incidence of complications. In the last section of this review, we describe related issues about the preparation and post-insertion care of PEG. In conclusion, PEG tube placement is a widely accepted technique that can bring benefits to the right patients.

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“…Nevertheless, large studies evaluating those methods are lacking and long-term resolution of chronic fistulas was obtained in less than 50% of cases [8,9]. Therefore, as previously proposed in case reports [10][11][12][13][14][15], we combined two approaches with both Endoscopic submucosal dissection (ESD) of the surrounding mucosa in order to promote healing combined with clip closure into the submucosal space to increase the chances of tight healing (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, as previously proposed in case reports [10][11][12][13][14][15], we combined two techniques: endoscopic submucosal dissection (ESD) of the surrounding mucosa in order to promote healing, combined with clip closure into the submucosal space (FESDC) to increase the chances of tight healing (▶ Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy

et al. 2021

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Objective: Gastrointestinal (GI) fistula, a life-threatening condition, represents a therapeutic challenge. Rescue surgery could be hazardous and/or impact quality of life justifying endoscopic con-servative approach including mucosal abrasion, clip closure or stent diversion with moderate success rates in the long term. We assessed whether Fistulas Endoscopic Submucosal Dissection with clip Closure (FESDC) could lead to complete resolution of fistulas even if previous endoscopic therapy failed. Results: 23 patients with GI fistulas were retrospectively included, 57% of those were defined as refractory fistulas since previous endoscopic treatment failed. Tight immediate sealing was obtained for 19 patients (83% [95% CI: 61%, 95%]) who received FESDC. Long term closure (>3 months) was obtained in 14 cases (61% [95% CI: 39%, 80%]) with a median follow-up of 20 months. Ad-verse events occurred in 9% of cases. Previous local malignancy (p=0.077) or radiation therapy (p=0.047) were associated with a higher risk of failure. Conclusion: The new FESDC strategy is safe and allows permanent endoscopic closure of GI fistulas in 61% of the patients, and 54% of those with previous attempt. Further studies are war-ranted to determine the place of this technic in the management of chronic GI fistula.

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Closure of non-healing gastrocutaneous fistula after percutaneous endoscopic gastrostomy by endoscopic submucosal dissection and over-the-scope clip

Cited by 9 publications

References 5 publications

Over-the-Scope Clip Closure of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Tube Removal: A Report of Two Cases

Over-the-Scope Clip Closure of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Tube Removal: A Report of Two Cases

Percutaneous endoscopic gastrostomy

Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy

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