Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study

Abstract

Background and study aims Esophageal fistulas after esophagectomy are associated with high mortality and poor quality of life. They are sometimes intractable to conservative management and surgery that increases mortality. Few studies have assessed use of polyglycolic acid (PGA) sheets with fibrin glue for esophageal fistulas. We investigated the safety of using PGA sheets with fibrin glue for esophageal fistulas after esophagectomy. Patients and methods This was a single-center prospective pilot study. Patients who had refractory esophageal fistulas after esophagectomy were included. PGA sheets were filled in the fistula using biopsy forceps. Fibrin glue was applied to the PGA sheets. We repeated the procedure 1 week later. The outcome measures were the incidence of adverse events (AEs) and closure of the fistula. Results Five patients were assessed. No adverse events were observed. The esophageal fistula was closed with the application of PGA sheets four times in 40 % (2/5) of the cases. Conclusions PGA sheets with fibrin glue were safe for esophageal fistula closure after esophagectomy and do not involve the risk of AEs.

Combined endoscopic-percutaneous treatment of upper gastrointestinal enterocutaneous fistula using vacuum therapy and resorbable plug insertion (Vac-Plug)

“…Another group described polyglycolic acid sheets combined with fibrin glue for esophageal fistulas following esophagectomies in a series of five patients with a reported closure rate of 40% 19 . Further closure methods combine anal fistula plug insertion and mucosal covering with endoscopic sutures using the Apollo overstitch system, as just recently described in a video case report 20 .…”

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

“…Endoscopic therapy is often effective (70 %-80 %) for closure of acute perforations and leakages [3,17]; however, results are disappointing in cases of chronic fistulas, with less than 50 % of fistulas achieving long-term healing [6,7,9,18,19].…”

“…Surgical management of fistulas is associated with high morbidity and mortality. Endoscopic closure of GI fistulas and acute leaks was first proposed in the 1990 s as a conservative alternative comprising different modalities [2], including stent diversion [3,4], clip closure [5,6], endoscopic suturing, and glue injection [7]. However, large studies evaluating these methods are lacking, and long-term resolution of chronic fistulas has been achieved in less than 50 % of cases [8,9].…”

Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review

“…If a patient’s general condition is good, we may perform the second and third procedure at the same time. In recent years, successful cases of endoscopic fistula closure have been reported [ 23 , 24 ], and this may become a treatment option. However, we did not choose endoscopic treatment in our case because we were concerned that aspiration pneumonia and respiratory failure due to the EBF would be exacerbated by endoscopic insufflation.…”