Fibrin Glue as Adjuvant Treatment for Gastrocutaneous Fistula after Gastrostomy Tube Removal

Abstract

Gastrocutaneous fistulas are infrequent after gastrostomy tube removal. However, if the fistulous tract remains permeable, even low-volume output can produce significant cutaneous burns. The use of biodegradable adhesives has been described, where fibrin glue is applied directly over the fistulous tract or under the guidance of procedures such as upper or lower gastrointestinal endoscopy or fistuloscopy. We studied the use of fibrin glue in five consecutive adult patients with gastrocutaneous fistulas after gastrostomy tube removal, with no complications that might impede spontaneous closure. A comparison group included seven patients treated during the preceding 2 years with conservative medical management, who were not treated with fibrin glue. There was no difference between the two groups with regard to age and gender, nor with regard to type of gastrostomy (surgical or endoscopic). The mean output volume from the fistulas was 151.4 +/- 146.1 ml/24 h in the study group and 115.0 +/- 42.7 ml/24 h in the control group, which was not significantly different ( P = 0.80). The duration of previous conservative treatment was 93.8 +/- 85.1 days for the study group and 95.8 +/- 80.7 days for the control group and this also did not differ significantly ( P = 0.93). The time to achieve total fistula closure was 7.0 +/- 3.1 days in the study group and 32.7 +/- 15.7 days in the control group. This difference was statistically significant ( P < 0.004). The time required before oral feeding could be recommenced after spontaneous or induced closure was similar in the two groups, at 2.8 +/- 1.3 days and 4.71 +/- 2.36 days, respectively. Endoscopic guidance allows direct instillation of fibrin glue via the external opening through the whole fistulous tract. This procedure reduces the time required for the closure of gastrocutaneous fistulas.

Endoscopic Fibrin Sealant Injection with Application of Hemostatic Clips: A Novel Method of Closing a Refractory Gastrocutaneous Fistula

“…The specific beneficial effect of fibrin sealant on bowel falling within the radiation field has long been recognized (17). External plugging and fibrin sealant using reagents similar to our case has recently been reported in a small controlled series (18). However, those patients had not undergone irradiation and chemotherapy, and the technique differed from ours in that no hemostatic clips were applied.…”

Extraperitoneal Closure of Persistent Gastrocutaneous Fistula in Children

“…5 Fibrin tissue glue has also been used with some success. 6 Most the data available for the above-mentioned techniques involves case studies or small-scale reviews, and the success of complete closure is questionable. The extraperitoneal technique we describe has lower morbidity, shorter hospital stay, and is more cost effective than the traditional layered closure.…”

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

“…3 Reports of endoscopic clipping and suturing techniques continue to appear in the literature. 4,5 Another technique involves filling of the GC fistula tract with biosynthetic glues, 6 an approach that requires significant endoscopic aptitude and is generally used as an adjuvant to other treatments such as serial tract debridement. 7 In the single published attempt at plugging a GC fistula endoscopically with a collagen plug, the repair failed due to dislodgement of the collagen plug.…”