Gastrointestinal fistula endoscopic closure techniques

Bhurwal, Abhishek; Mutneja, Hemant; Tawadross, Augustine; Pioppo, Lauren; Brahmbhatt, Bhaumik

doi:10.20524/aog.2020.0543

Cited by 12 publications

(10 citation statements)

References 69 publications

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“…3 Standard EVT is also not applicable in these cases because of technical limitations (length of overtube and devices). 4 However, vacuum stimulates the healing of leaks and fistulas through granulation tissue's formation and would be very effective also in this setting. [5][6][7] In the present paper, we present the experience of our center in endotherapy of duodenal stump's dehiscence using an innovative application of EVT.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Mutignani

Dioscoridi

Massad

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction: The usefulness of endoscopic vacuum therapy (EVT) in the setting of postoperative gastrointestinal leaks is widely described. On this basis, we would like to focus a specific application of EVT: the dehiscence of the duodenal stump after upper gastrointestinal surgery. Standard EVT is not applicable in these cases because of technical limitations (length of overtube and devices). However, vacuum stimulates the healing of leaks and fistulas through granulation tissue’s formation and would be effective also in this setting. Materials and Methods: Between October 2019 and January 2020, 7 consecutive patients (4 M, 3 F, 62±9 y old) affected by duodenal stump’s dehiscence were endoscopically treated by the placement of a large-bore (14 to 18 Ch) suction tube across the wall’s defect into the peritoneal cavity. Continuous aspiration at −80/−100 mm Hg was applied. Clinical success was established both by fluoroscopic check injecting contrast medium from the tube to verify the fistula’s closure and by abdominal computed tomography scan to exclude residual fluid collections. Results: Technical and clinical success were achieved in all the patients. The suction tube was maintained in site for 12±5 days in continuous aspiration. The drainage’s output became null in 2±1 days without any intra-abdominal residual fluid collection. The principle of this technique is to let the duodenal walls’ stump to collapse on the intraluminal part of the tube (with subsequent mucosal intussusception into the holes of the tube itself) creating a sort of vacuum-packed barrier to interrupt the outflow of enteric materials into the fistula’s path. It guarantees the fistula’s closure by the gradual formation of granulation tissue. Conclusions: The present technique offers a safe and viable endoscopic alternative to treat duodenal stump’s leaks after upper gastrointestinal surgery.

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Section: Discussionmentioning

confidence: 99%

“…Standard EVT is also not applicable in these cases because of technical limitations (length of overtube and devices) 4. However, vacuum stimulates the healing of leaks and fistulas through granulation tissue’s formation and would be very effective also in this setting 5–7…”

mentioning

confidence: 99%

Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Mutignani

Dioscoridi

Massad

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The new Padlock Clip is an innovative and versatile alternative. It has been used and successfully described in the literature by some reports or case series for use in gastrointestinal fistula [ 10 ], such as to stop recurrent bleeding and to close perforations or fistula at different levels [ 6 ]. For our patient, the Padlock Clip therapeutic result has been successful so far.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment Using the Padlock Clip System for Rectourethral Fistula After Prostatectomy

Azambuja¹,

Trindade²,

Motter³

et al. 2023

Cureus

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We present a case of a 68-year-old man with a rectourethral fistula (RUF) successfully treated with a unique endoscopic approach using the Padlock Clip system (Steris, Basingstoke, UK). This is a complex case of a patient who, after radical prostatectomy, continued to show several complications, including fistulas and relapses. Our work aims to enhance the literature with our technique and to help the scientific community in future RUF cases. Our case stands out because this therapeutic approach has not yet been described in the literature as a possible endoscopic treatment of RUF. Therefore, our topic description is essential to assist future similar cases.

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“…In this regard, the ability to obtain a shortened and straight endoscope is vital to ensure the ease of maneuverability during OTSC application. The surrounding colonic mucosa should also be healthy and not friable or necrotic to encourage optimal OTSC deployment (20).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic closure of a radiation induced colovesical fistula using the novel over-the-scope Padlock Clip system—a case report

Chiam¹,

Muthukaruppan²

2021

AME Surg J

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Colovesical fistulas (CVFs) are known complications of complicated diverticular disease, malignancy, and Crohn's colitis (1). With the increasing use of radiation therapy in relation to pelvic malignancies, we now have a rising incidence of benign radiation induced CVF that could potentially lead to recurrent bouts of cystitis, pyelonephritis, renal abscesses, renal impairment and systemic infection resulting from ongoing fecal contamination through the abnormal connection (2). The complications of urosepsis, in particular, carry high morbidity and mortality, and thus CVF should generally be an indication for surgical repair to avoid these problems (3). Unfortunately, not all patients are fit

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Gastrointestinal fistula endoscopic closure techniques

Cited by 12 publications

References 69 publications

Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series

Endoscopic Treatment Using the Padlock Clip System for Rectourethral Fistula After Prostatectomy

Endoscopic closure of a radiation induced colovesical fistula using the novel over-the-scope Padlock Clip system—a case report

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