Efficacy and safety of over-the-scope clips (OTSC®) for closure of gastrointestinal fistulas less than 2 cm

Zhang, Juanjuan; Da, Binlin; Diao, Yanqing; Qian, Xinming; Wang, Gefei; Gu, Guosheng; Wang, Zhiming

doi:10.1007/s00464-021-08904-1

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Fibrin glue sealing is effective at restoring intestinal integrity in patients with multiple fistulas[ 23 ]. The application of the over-the-scope clip was reported to have an approximately 70% ECF closure rate[ 24 ]. However, for distal fistulas, there are no appropriate methods for EN administration.…”

Section: Discussionmentioning

confidence: 99%

New application of intestinal obstruction catheter in enterocutaneous fistula: A case report

Wang,

Liu

et al. 2024

World J Clin Cases

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BACKGROUND Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin. ECF can lead to massive body fluid loss, hypercatabolism, and malnutrition. Therefore, nutritional support plays a crucial role in managing ECFs and promoting the healing of fistulas. For nutritional support, enteral nutrition (EN) is the preferred method when gastrointestinal function is recovering. Currently, various EN approaches have been applied for different anatomical positions of the ECF. However, the effectiveness of administering EN support for treating lower ECFs still needs further exploration and improvement. CASE SUMMARY We present the case of a 46-year-old male who underwent gastrointestinal stromal tumour resection. Six days after the surgery, the patient presented with fever, fatigue, severe upper abdominal pain, and septic shock. Subsequently, lower ECFs were diagnosed through laboratory and imaging examinations. In addition to symptomatic treatment for homeostasis, total parenteral nutrition support was administered in the first 72 h due to dysfunction of the intestine. After that, we gradually provided EN support through the intestinal obstruction catheter in consideration of the specific anatomic position of the fistula instead of using the nasal jejunal tube. Ultimately, the patient could receive optimal EN support via the catheter, and no complications were found during the treatment. CONCLUSION Nutritional support is a crucial element in ECF management, and intestinal obstruction catheters could be used for early EN administration.

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Section: Discussionmentioning

confidence: 99%

New application of intestinal obstruction catheter in enterocutaneous fistula: A case report

Wang,

Liu

et al. 2024

World J Clin Cases

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“…There are some reports of minimally invasive treatments for REF, such as the use of over-the-scope clip [13] and brin glue.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for refractory enterocutaneous fistula following button jejunostomy removal and its treatment using a novel extraperitoneal approach in patients with esophageal cancer: A retrospective cohort study

Kamada

Ohdaira

Nakashima

et al. 2022

Preprint

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BackgroundEnterocutaneous fistula after removal of the jejunostomy tube leads to multiple problems, such as cosmetic problems, decreased quality of life, electrolyte imbalances, infectious complications, and increased medical costs. However, the risk factors for refractory enterocutaneous fistula (REF) after button jejunostomy removal remain unclear. Therefore, in this study, we assessed the risk factors for REF after button jejunostomy removal in patients with esophageal cancer and reported the surgical outcomes of the novel extraperitoneal approach (EPA) for REF closure.MethodsThis retrospective cohort study included 47 patients who underwent button jejunostomy removal after esophagectomy for esophageal cancer. We assessed the risk factors for REF in these patients and reported the surgical outcomes of the novel EPA for REF closure at the International University of Health and Welfare Hospital between March 2013 and October 2021. The primary endpoint was defined as the occurrence of REF after removal of the button jejunostomy, which was assessed using a maintained data base. The risk factors and outcomes of the EPA for REF closure were retrospectively analyzed.ResultsREFs occurred in 15 (31.9%) patients. In the univariate analysis, REF was significantly more common in patients with albumin level<4.0 g/dL (p=0.026), duration>12 months for button jejunostomy removal (p=0.003), and with a fistula<15.0 mm (p=0.002). The multivariate analysis revealed that a duration>12 months for button jejunostomy removal (odds ratio [OR]:7.15; 95% confidence interval [CI]: 1.38–36.8; p=0.019), and fistula<15.0 mm (OR: 8.08; 95% CI: 1.50–43.6; p=0.002) were independent risk factors for REF. EPA for REF closure was performed in 15 patients. The technical success rate of EPA was 88.2%. Of the 15 EPA procedures, fistula closure was achieved in 12 (80.0%). The complications of EPA (11.7%) were major leakages (n=3) and for two of them, EPA procedure was reperformed, and closure of the fistula was finally achieved. ConclusionThis study suggested that duration>12 months for button jejunostomy removal and fistula<15.0 mm are the independent risk factors for REF after button jejunostomy removal. EPA for REF closure is a novel, simple, and useful surgical option for patients with REF after esophagectomy.

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“…Immediate fistula closure can be an effective option for patients waiting for spontaneous fistula closure that require a long period of time to close or those suffering from REF. There are some reports of minimally invasive treatments for REF, such as the use of over-the-scope clip [ 13 ] and fibrin glue [ 14 ]. The success rate is reported to be approximately 50–87.5%, but the applicable fistula is a small enterocutaneous fistula with a diameter of approximately 5 mm or a low-output enterocutaneous one.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for refractory enterocutaneous fistula following button jejunostomy removal and its treatment using a novel extraperitoneal approach in patients with oesophageal cancer: a retrospective cohort study

et al. 2022

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Background Enterocutaneous fistula after removal of the jejunostomy tube leads to multiple problems, such as cosmetic problems, decreased quality of life, electrolyte imbalances, infectious complications, and increased medical costs. However, the risk factors for refractory enterocutaneous fistula (REF) after button jejunostomy removal remain unclear. Therefore, in this study, we assessed the risk factors for REF after button jejunostomy removal in patients with oesophageal cancer and reported the surgical outcomes of the novel extraperitoneal approach (EPA) for REF closure. Methods This retrospective cohort study included 47 patients who underwent button jejunostomy removal after oesophagectomy for oesophageal cancer. We assessed the risk factors for REF in these patients and reported the surgical outcomes of the novel EPA for REF closure at the International University of Health and Welfare Hospital between March 2013 and October 2021. The primary endpoint was defined as the occurrence of REF after removal of the button jejunostomy, which was assessed using a maintained database. The risk factors and outcomes of the EPA for REF closure were retrospectively analysed. Results REFs occurred in 15 (31.9%) patients. In the univariate analysis, REF was significantly more common in patients with albumin level < 4.0 g/dL (p = 0.026), duration > 12 months for button jejunostomy removal (p = 0.003), and with a fistula < 15.0 mm (p = 0.002). The multivariate analysis revealed that a duration > 12 months for button jejunostomy removal (odds ratio [OR]: 7.15; 95% confidence interval [CI]: 1.38–36.8; p = 0.019) and fistula < 15.0 mm (OR: 8.08; 95% CI: 1.50–43.6; p = 0.002) were independent risk factors for REF. EPA for REF closure was performed in 15 patients. The technical success rate of EPA was 88.2%. Of the 15 EPA procedures, fistula closure was achieved in 12 (80.0%). The complications of EPA (11.7%) were major leakages (n = 3) and for two of them, EPA procedure was re-performed, and closure of the fistula was finally achieved. Conclusion This study suggested that duration > 12 months for button jejunostomy removal and fistula < 15.0 mm are the independent risk factors for REF after button jejunostomy removal. EPA for REF closure is a novel, simple, and useful surgical option for patients with REF after oesophagectomy.

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Efficacy and safety of over-the-scope clips (OTSC®) for closure of gastrointestinal fistulas less than 2 cm

Cited by 6 publications

References 22 publications

New application of intestinal obstruction catheter in enterocutaneous fistula: A case report

New application of intestinal obstruction catheter in enterocutaneous fistula: A case report

Risk factors for refractory enterocutaneous fistula following button jejunostomy removal and its treatment using a novel extraperitoneal approach in patients with esophageal cancer: A retrospective cohort study

Risk factors for refractory enterocutaneous fistula following button jejunostomy removal and its treatment using a novel extraperitoneal approach in patients with oesophageal cancer: a retrospective cohort study

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