Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review

Abstract

Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopic approaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported. We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. The primary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management. A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved in all cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was 22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the success of closure and adverse events in relation to several variables among the subgroups. The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived from this sparse literature suggest that it can be an option in the management of GI fistulas.

Management of Chronic Fistula Using the Cardiac Septal Defect Occluder

“…The only systematic review and meta-analysis regarding CSDOs in the literature for management GI istulas was previously published by our group [10]. In this review, we analyzed 19 case reports including 22 istulas among 20 total patients.…”

Colovaginal fistula closure using a cardiac septal defect occluder

“…The devices are made of material that is self-expanding and, when activated, result in tissue ingrowth and device occlusion. 3

Figure 1 Cardiac septal defect occluder device under manual traction. The device is an asymmetrical double-disk device with a short waist.

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

“…A CSDO is a double-disc self-expanding closure device made of nitinol and interwoven polyester. The successful use of CSDOs in the management of gastrointestinal surgical and bariatric leaks has been reported; however, there are limited data regarding long-term outcomes [3,4]. In this video, we describe the successful closure of a gastrocutaneous fistula using a CSDO and demonstrate persistent closure at long-term follow-up (▶ Video 1).…”