Successful closure of a refractory rectal anastomotic fistula using endoscopic submucosal dissection combined with an over-the-scope clip

Abstract

Video 1 Endoscopic submucosal dissection of a patch of mucosa surrounding the fistulous orifice followed by over-the-scope clip (OTSC) closure.▶ Fig. 3 Endoscopic submucosal dissection of the mucosal area around fistulous orifice before clip closure. Endoscopic appearance: a of the fistulous orifice; b following submucosal injection; c after mucosal incision; d of the perifistulous mucosal defect after dissection and cold forceps avulsion. E100Barsic Neven et al. ESD with OTSC for refractory rectal anastomotic fistula … Endoscopy 2018; 50: E99-E101

Endoscopic closure of a postoperative rectal anastomotic leakage with hemoclips: A case report

“…However, it is still rarely used in the case of small leakages in rectal anastomosis after low anterior resection. Barsic et al [ 11 ] reported closure of an anastomotic leakage of the rectum in a single patient, however in this case an over-the-scope clip (OTSC,12/6 T; Ovesco, Tubingen, Germany) was utilized. Kadir et al [ 12 ] reported successful closure of an extraperitoneal rectal perforation with endoscopic hemoclips which occurred during transurethral urologic surgery.…”

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

“…Nevertheless, large studies evaluating those methods are lacking and long-term resolution of chronic fistulas was obtained in less than 50% of cases [8,9]. Therefore, as previously proposed in case reports [10][11][12][13][14][15], we combined two approaches with both Endoscopic submucosal dissection (ESD) of the surrounding mucosa in order to promote healing combined with clip closure into the submucosal space to increase the chances of tight healing (Figure 1).…”

“…Therefore, as previously proposed in case reports [10][11][12][13][14][15], we combined two techniques: endoscopic submucosal dissection (ESD) of the surrounding mucosa in order to promote healing, combined with clip closure into the submucosal space (FESDC) to increase the chances of tight healing (▶ Fig. 1).…”

Successful closure of a rectovesical fistula after radical prostatectomy using endoscopic submucosal dissection combined with an over-the-scope clip

“…Few cases of endoscopic treatment are currently reported with disappointing results [1]. Endoscopic submucosal dissection (ESD) of the fistula orifice combined with a clip closure has been described as effective for chronic oeso-tracheal [2,3] and rectal [4] fistulas after surgery or Crohn's disease [5]. We report here the first success of this technique, with video illustration (▶ Video 1), to treat a rectovesical fistula occurring after radical prostatectomy for adenocarcinoma.…”