Endoscopic-Assisted Closure of Persistent Gastrocutaneous Fistula With a Porcine Fistula Plug: Report of a New Technique

Abstract

Persistent gastrocutaneous (GC) fistula is a rare but problematic complication of gastrostomy feeding tube removal. Several techniques for nonoperative fistula closure have been attempted with mixed results. None has proven both satisfactorily simple and consistently effective. The authors present a case of persistent GC fistula treated by a simple outpatient endoscopic-assisted procedure using a porcine anal fistula plug. The procedure requires only basic endoscopic skills, similar to percutaneous gastrostomy tube placement, and it involves minimal operative time and risk to the patient. This technique offers a potential solution to the troublesome problem of persistent GC fistula.

Gastro-cutaneous fistula treated with trionic (cell alginate activate packing)

“…In these seven cases, there were no further problems [ 7 ]. Wood, with his fellow researchers, demonstrated a successful closure of a persistent gastrocutaneous fistula after removal of feeding gastrostomy in combination of clip in the inner opening with endoscopy [ 8 ].…”

Successful closure of gastrocutaneous fistulas using the Surgisis® anal fistula plug

“…[6][7][8] Innovators from the US have already described the use of the Surgisis ® anal fistula plug as a minimally invasive therapy for the management of fistulas not in the perineum. Wood et al described the successful closure of a solitary persistent gastrocutaneous fistula following removal of a PEG tube with a porcine fistula plug 9 and Paul et al describe similar success closing a solitary bronchopleural fistula following a partial pneumonectomy. 10 We have also described the successful use of the Surgisis ® anal fistula plug in closing three oesophagocutaneous fistulas as part of minimally invasive endoscopic therapy for the management of Boerhaave's syndrome.…”