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

Abstract

Objective: Gastrointestinal (GI) fistula, a life-threatening condition, represents a therapeutic challenge. Rescue surgery could be hazardous and/or impact quality of life justifying endoscopic con-servative approach including mucosal abrasion, clip closure or stent diversion with moderate success rates in the long term. We assessed whether Fistulas Endoscopic Submucosal Dissection with clip Closure (FESDC) could lead to complete resolution of fistulas even if previous endoscopic therapy failed. Results: 23 patients with GI fistulas were retrospectively included, 57% of those were defined as refractory fistulas since previous endoscopic treatment failed. Tight immediate sealing was obtained for 19 patients (83% [95% CI: 61%, 95%]) who received FESDC. Long term closure (>3 months) was obtained in 14 cases (61% [95% CI: 39%, 80%]) with a median follow-up of 20 months. Ad-verse events occurred in 9% of cases. Previous local malignancy (p=0.077) or radiation therapy (p=0.047) were associated with a higher risk of failure. Conclusion: The new FESDC strategy is safe and allows permanent endoscopic closure of GI fistulas in 61% of the patients, and 54% of those with previous attempt. Further studies are war-ranted to determine the place of this technic in the management of chronic GI fistula.

Endoscopic closure of a gastric perforation using mucosal adaptative ring to close endoscopic artificial ulcer: the MARCEAU system

“…A large gastric hole was visualized. We decided to perform an endoscopic submucosal dissection of the surrounding mucosal patch to facilitate fistula closure 3 . Then, we used a previously described adaptative suture device to close the leak.…”

Successful Closure of a Refractory Gastrobronchial Fistula Combining Endoscopic Submucosal Dissection and Argon Ablation plus single-loop-and-clip Techniques

“…Comments: Successful treatment of a chronic persistent fistula between the digestive tract and the trachea-bronquial tree, by combination of various endoscopic closure techniques. 1…”

Successful closure of a refractory gastrobronchial fistula using endoscopic mucosal ablation followed by single loop-and-clips technique

“…Recently, some French investigators have reported the use of ESD followed by the application of an OTS clip for the treatment of severe fistulas. However, this method can fail in some cases [1][2][3].…”