Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas

Prosst, Ruediger L.; Joós, A

doi:10.1007/s10151-016-1537-0

Cited by 49 publications

(22 citation statements)

References 14 publications

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“…This is an example of a surgical procedure addressing more than one pathophysiological factor but still failing in most cases, perhaps because other factors, such as those discussed above, were left untreated. Closure of the internal opening alone, whether in the “placebo” arm of this trial or by the over‐the‐scope clip, where a 45% healing rate has been shown in (small numbers of) IBD fistulae, has not demonstrated a success rate as high as some other techniques but the partial efficacy does support the idea that disconnection at the level of the internal opening represents one aspect of pathophysiology which should be addressed by any successful technique.…”

Section: Methodsmentioning

confidence: 82%

Review article: pathogenesis of Crohn's perianal fistula—understanding factors impacting on success and failure of treatment strategies

Tozer

Lung

Lobo

et al. 2018

Aliment Pharmacol Ther

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Section: Methodsmentioning

confidence: 82%

Review article: pathogenesis of Crohn's perianal fistula—understanding factors impacting on success and failure of treatment strategies

Tozer

Lung

Lobo

et al. 2018

Aliment Pharmacol Ther

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“…A large, multicenter, retrospective study of treatment of gastrointestinal defects using OTSCs revealed an overall success rate of 60.2 %, but the rate for fistulas (42.9 %) was worse than that for perforations (90 %) and leaks (73.3 %) 7 . Regarding short-term outcomes of OTSCs for recurrent RVFs, the success and healing rates were 26 % and 20 %, respectively 3 . As mentioned above, other procedures are necessary to firmly close recurrent RVF.…”

Section: Discussionmentioning

confidence: 98%

“…Recently, over-the-scope clips (OTSC) have been applied for closure of gastrointestinal defects. However, the rate of successful closure of fistulae is less than 50 % and is affected by presence of induration or fibrosis 3 . Thus, there are no available treatments for refractory RVF.…”

Section: Introductionmentioning

confidence: 99%

Successful endoscopic closure of a refractory postoperative rectovaginal fistula

et al. 2019

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Background and study aims A 71-year old female who received low anterior resection for rectal cancer visited Komatsu Municipal Hospital with complaints of passing feces from the vagina. Endoscopic examination revealed a postsurgical rectovaginal fistula. Medical approaches, including nonoperative management, initial endoscopic closure, transvaginal and endorectal surgery, and fecal diversion, were unsuccessful. Therefore, the patient underwent endoscopy with a pre-procedural endoscopic creation of mucosal pin holes around the fistula opening and clip insertion into the rectal wall in combination with electrocautery and clip closure. This novel approach was effective in achieving permanent closure of the fistula in a single procedure. Most rectovaginal fistulas are surgically managed, however, surgery may be more difficult, invasive, and unsatisfactory for refractory fistulas. Although endoscopic treatment with over-the-scope clips has been increasingly used as a less invasive approach for gastrointestinal fistulas with favorable results, it is not as effective for refractory rectovaginal fistulas. As a minimally invasive surgical procedure, this approach might be effective in small rectovaginal fistulas, particularly refractory ones.

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“…A number of interposition flaps/grafts have been used including muscle flaps (gracilis, Martius flaps), omental flaps, 94 porcine dermal matrix 95 and more recently (for anovaginal fistulae) autologous fat graft injection 96 . Clips have been trialled as a minimally invasive alternative 97 . Glue is uncommonly used due to high failure rates 36,98 …”

Section: Methodsmentioning

confidence: 99%

“…96 Clips have been trialled as a minimally invasive alternative. 97 Glue is uncommonly used due to high failure rates. 36,98 If the anal sphincter muscles are damaged by the fistulae, sphincter repair should be considered.…”

Section: Ta B L E 4 (Continued)mentioning

confidence: 99%

Review article: investigation and management of internal fistulae in Crohn’s disease

Tjandra

Garg

Behrenbruch

et al. 2021

Aliment Pharmacol Ther

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SummaryBackgroundCrohn’s disease is an inflammatory, penetrating intestinal disease associated with fistula formation. Fistulae in Crohn’s disease can be classified into external and internal fistulae. Internal fistulae form between the gastrointestinal tract and another internal organ and include enteroenteric, enterocolic, enterovesical and rectovaginal fistulae. They are associated with significant morbidity and a decreased quality of life.AimTo review the classification, diagnosis, medical and surgical management of internal fistulae in Crohn’s disease, and propose a treatment algorithm.MethodsA literature review on internal fistulae in Crohn’s disease in the adult population was undertaken, synthesised and summarised.ResultsInternal fistulae occur in up to 15% of patients with Crohn’s disease. Multi‐modal assessment including a combination of endoscopy and cross‐sectional imaging, usually magnetic resonance, is required to diagnose fistulae and determine extent of disease. Determining optimal treatment strategies for these complex fistulae remains a challenge due to limited and generally low‐quality data. Most studies to date have focussed on luminal disease, with (usually post hoc) outcomes more often reported for external fistulae, particularly perianal fistulae, than internal fistulae. Anti‐tumour necrosis factor therapies have emerged as the mainstay of medical therapy, with particularly promising data for enterovesical fistulae, but many patients will still require surgical intervention. The indications and optimal timing of surgery vs medical therapy remains uncertain; thus multi‐disciplinary input when making such decisions is important.ConclusionsInternal fistulae result in significantly increased morbidity in Crohn’s disease, and further studies to determine optimal multi‐modality management strategies incorporating medical and surgical therapy are required.

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Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas

Abstract: OTSC Proctology provides convincing results as first-line treatment for complex cryptoglandular fistulas. It is a safe, effective, minimally invasive, and sphincter-sparing procedure with postoperative pain comparable to other types of fistula surgery.

Cited by 49 publications

References 14 publications

Review article: pathogenesis of Crohn's perianal fistula—understanding factors impacting on success and failure of treatment strategies

Review article: pathogenesis of Crohn's perianal fistula—understanding factors impacting on success and failure of treatment strategies

Successful endoscopic closure of a refractory postoperative rectovaginal fistula

Review article: investigation and management of internal fistulae in Crohn’s disease

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