Closure of recurrent colovaginal fistulas using AMPLATZER occluder device

Abstract

A 79-year-old woman and a 92-year-old woman were referred to the gastroenterology department for management of persistent colovaginal fistula despite surgical and non-surgical management. Both patients had several hospitalisations for recurrent urinary tract infections. After failed surgical management and endoscopy using over-the-scope clipping, both patients underwent endoscopic closure using the Amplatzer cardiac septal occluder device. Both patients underwent successful closure and had no recurrence of symptoms at 6-month follow-up. Although there are several therapies available for persistent colovaginal fistulas, most involve multiple sessions and have high recurrence rate. There have been reports in the literature of cardiac septal occluders being used in the management of upper gastrointestinal tract fistulas, but few cases exist explaining their role in the management of colovaginal fistulas. Our cases demonstrate that cardiac septal occluders may be a viable option for management of fistulas and warrants further studies to reproduce its effectiveness and safety.

Gynecological Fistulae—Has Anything Changed in the Diagnosis and Treatment over the Last Decade? A Narrative Literature Review

“…There are different methods of treatment of VVF, including fulguration, occluding devices, prolonged catheterization, open repair, and laparoscopic or robotic surgery [ 9 , 10 , 11 , 12 ]. The typical treatment for gynecological fistulae is the surgical excision of the abnormal connection to reestablish normal function.…”

Endoscopic Deployment of Cardiac Septal Occluder Device to Close an Enterovaginal Fistula

“…Although evidence is limited, previous case reports have demonstrated the success of CSO implantation to close EF, particularly in elderly patients with multiple comorbidities. 5 CSOs are believed to promote fistula closure by promoting tissue in-growth and occluding the fistula tract. 4 Although initial interventional radiology and advanced gastroenterology techniques were unsuccessful in our patient, the employment of the Amplatzer CSO resulted in significant improvement in her functional well-being and overall health status.…”

Endoscopic closure of a rectal fistula using a cardiac septal defect occluder: the final redemption

“…CSDO is an off-label device for closure of gastrointestinal fistulas and should be considered for chronic fistulas refractory to conventional endoscopic treatments 1 2 . To date, only four cases of lower gastrointestinal fistula (all rectovaginal) closure with CSDO have been reported 3 4 5 . To the best of our knowledge, this is the first case of endoscopic closure of a fistula between the rectum and surgical site.…”