Long-term endoscopic follow-up after closure of a post-bariatric surgery fistula with a cardiac septal defect occluder

Boghossian, Mateus Bond; Hirsch, Bruno Salomão; McCarty, Thomas R.; Baptista, Alberto; Moura, Eduardo Guimarães Hourneaux de

doi:10.1055/a-1422-2631

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…Different from several studies, 5,8,14,28 we reported the use of adjunctive endoscopic approaches in a substantial part of our population. This finding is related to our experience in treating these challenging conditions, as described in Methods 27,29–34 . It is important to state that there is no gold standard method to treat TGID.…”

Section: Discussionmentioning

confidence: 64%

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Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Hirsch

McCarty

Santos

et al. 2023

Digestive Endoscopy

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ObjectivesEndoscopic vacuum therapy (EVT) possesses a unique mechanism of action providing a less invasive alternative for the management of transmural gastrointestinal defects (TGID). This study evaluates the efficacy and safety of a novel homemade EVT (H‐EVT) for the treatment of TGID.MethodsRetrospective multicenter study including patients who underwent H‐EVT for TGID between January 2019 and January 2022. Main outcomes included technical and clinical success as well as safety outcomes. Subgroup analyses were included by defect location and classification. Logistic regression analyses were performed to determine predictors for successful closure.ResultsA total of 144 patients were included. Technical success was achieved in all patients, with clinical success achieved in 88.89% after a mean of 3.49 H‐EVT exchanges over an average of 23.51 days. After excluding 10 cases wherein it was not possible to achieve negative pressure, successful closure occurred in 95.52% of patients. Time to clinical success was less for defects caused by endoscopic (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.33–1.20) compared to surgical procedures and for patients with simultaneous intracavitary and intraluminal H‐EVT placement (HR 0.70; 95% CI 0.55–0.91). Location and classification of defect did not impact clinical success rate. Simultaneous placement of both an intraluminal and intracavitary H‐EVT (odds ratio 3.08; 95% CI 1.19–7.95) was a significant predictor of clinical success. Three device‐related adverse events (2.08%) occurred.ConclusionsThe use of the H‐EVT is feasible, safe, and effective for the management of TGID.

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Section: Discussionmentioning

confidence: 64%

“…This finding is related to our experience in treating these challenging conditions, as described in Methods. 27,[29][30][31][32][33][34] It is important to state that there is no gold standard method to treat TGID. An individualized approach considering personal/local experience is required.…”

Section: Discussionmentioning

confidence: 99%

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Hirsch

McCarty

Santos

et al. 2023

Digestive Endoscopy

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“…The concept of the use of CSDO for the treatment of GI fistulas is not novel, albeit formally it is considered an off-label indication. Its use in the setting of post-bariatric fistula treatment is still very limited to a small number of case reports [ 5 , 10 , 11 , 12 ]. To the best of the authors’ knowledge, no reports on the use of the Occlutech® devices for this purpose are available comparable to former studies with the Amplatzer TM Occluders.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Early results suggest this technique is particularly useful for poor surgical candidates with chronic GI fistulas that have had failure of closure attempted with standard endoscopic methods [ 8 ]. In these cases, the persistent inflammation, fibrosis, and epithelialization of the tract is often not liable to the application of clips, sutures, sealants, and conventional ablative techniques, leading to failed closure attempts in up to 20% of cases [ 12 ].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder

Fonseca

Coelho²,

Mânica

et al. 2022

GE Port J Gastroenterol

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Introduction: Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascular defects, including gastrointestinal (GI) disruptions. Previous case reports have reported similar results with the CSDO Amplatzer™ for the management of GI disruptions following bariatric surgery. However, the use of similar alternative devices for this purpose has not yet been described. Case Presentation: This case report presents the first reported use of the Occlutech® CSDO for the treatment of a chronic gastrocutaneous fistula after bariatric revisional surgery. Despite apparent initial success – no extravasation of contrast material through the device in the contrast study after the CSDO placement – fistula closure failed due to partial dislodgement of the device. The placement of a second device between the discs of the former one ultimately sealed the fistulous orifice. Discussion: In chronic GI fistulas, the mature tract is often not liable to the application of standard endoscopic methods, leading to failed closure attempts. A new application of Occlutech® CSDO can obviate the clinical burden of a high-risk laparotomy in these cases. Appropriate endoscopic equipment as well as the involvement of a multidisciplinary team are prime conditions to ensure successful patient outcomes.

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Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?

Hirsch

Neto

Oliveira

et al. 2023

Curr Treat Options Gastro

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Long-term endoscopic follow-up after closure of a post-bariatric surgery fistula with a cardiac septal defect occluder

Cited by 7 publications

References 5 publications

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects

Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder

Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?

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