Usefulness of over‐the‐scope clipping system for closing digestive fistulas

Mercky, Pascale; Gonzalez, Jean‐Michel; Bonin, Eduardo A.; Emungania, Olivier; Brunet, Julie; Grimaud, Jean–Charles; Barthet, Marc

doi:10.1111/den.12295

Cited by 100 publications

(70 citation statements)

References 37 publications

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“…2B-D). The average length of the stents was 12.38 ± 2.9 cm [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Five patients were treated by clips (4 Ovesco clips, 1 with standard clips), and 2 patients were placed a naso-fistula drain.…”

Section: Endoscopic Treatment Characteristicsmentioning

confidence: 99%

“…The overall mean number of endoscopies required per patient was 2.6 ± 1.57 [1][2][3][4][5][6][7][8][9][10]. The average number of esophageal stents used per patient was 1.6 ± 1.35 [0-7].…”

Section: Endoscopic Treatment Characteristicsmentioning

confidence: 99%

“…However, their high mortality rates, 60-100 and 40 %, respectively [7][8][9], lead to consider other therapeutic methods. Recently, the endoscopic management developed was demonstrated as effective in the treatment of fistulas complicating bariatric surgery by our team [10]. Several papers also suggested the effectiveness of clips [10,11] or covered esophageal stents [9,[12][13][14][15][16] for closing upper digestive tract fistulas.…”

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confidence: 99%

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Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series

Gonzalez¹,

Servajean²,

Aider³

et al. 2016

Surg Endosc

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Section: Endoscopic Treatment Characteristicsmentioning

confidence: 99%

Section: Endoscopic Treatment Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series

Gonzalez¹,

Servajean²,

Aider³

et al. 2016

Surg Endosc

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“…However, attempts to close chronic vesicorectal fistulas have so far been unsuccessful [4,5]. To our knowledge, this is the first report that describes the successful closure using an OTSC of a chronic vesicorectal fistula.…”

mentioning

confidence: 97%

“…OTSC closure is an effective treatment for acute (iatrogenic) perforations of the gastrointestinal tract [1 -4]. In one patient with an early vesicorectal fistula, OTSC application was successful in closing the fistula 5 days after surgery [5].However, attempts to close chronic vesicorectal fistulas have so far been unsuccessful [4,5]. To our knowledge, this is the first report that describes the successful closure using an OTSC of a chronic vesicorectal fistula.…”

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confidence: 99%

Successful closure of a chronic vesicorectal fistula after radical prostatectomy with an over-the-scope clip

et al. 2018

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Successful closure of a chronic vesicorectal fistula after radical prostatectomy with an over-the-scope clip A vesicorectal fistula after prostatectomy is a nightmare for the urologist. Treatment is challenging, invasive, and often unsuccessful. Endoscopic treatment using an over-the-scope clip (OTSC) may be an elegant alternative for the closure of such fistulas, even if they persist for several months after initial surgery. We report the case of a 62-year-old man with a vesicorectal fistula originating from the urethrovesical anastomosis after laparoscopic radical prostatectomy. A micturating cystourethrogram 7 weeks after surgery showed the presence of the fistula (▶ Fig. 1), which was treated conservatively at first because of minimal complaints. However, the fistula persisted and was confirmed by endoscopy (▶ Fig. 2). Fistula closure was performed 5 months after surgery using an OTSC (Ovesco). First, the fistula tract was visualized and debridement of the re-epithelialized fistula tract took place. An OTSC was then placed over the rectal orifice of the fistula, while regular checks were made -by moving the urethral catheter -for patency of the urethra (▶ Fig. 3; ▶ Video 1). Immediately after the procedure, the symptoms of pneumaturia and rectal urine loss disappeared and the patient has remained symptom-free until now, 18 months after the treatment. Endoscopy at 12 months demonstrated that the OTSC had disappeared and a scar was present as a result of the treatment, but there was no sign of a residual fistula. OTSC closure is an effective treatment for acute (iatrogenic) perforations of the gastrointestinal tract [1 -4]. In one patient with an early vesicorectal fistula, OTSC application was successful in closing the fistula 5 days after surgery [5].However, attempts to close chronic vesicorectal fistulas have so far been unsuccessful [4,5]. To our knowledge, this is the first report that describes the successful closure using an OTSC of a chronic vesicorectal fistula. The debridement of the re-epithelialized fistula tract is probably essential for long-term fistula closure in these patients. Endoscopy_UCTN_Code_TTT_1AQ_2AG▶ Fig. 1 Cystography after the bladder had been filled with contrast media showing contrast in the rectum because of a vesicorectal fistula.▶ Fig. 2 Colonoscopic views showing the epithelialized vesicorectal fistula: a before the instillation of indigo carmine into the urinary bladder via a transurethral catheter; b after the instillation of indigo carmine.▶ Fig. 3 Colonoscopic views showing: a after debridement of the fistula, the rectal fistula orifice being drawn into the cap of the over-the-scope clip (OTSC) system by applying gentle suction; b a retroflexed image of the rectum after OTSC placement. E-Videos E272Langers Alexandra MJ et al. Vesicorectal fistula closed by OTSC … Endoscopy 2018; 50: E272-E273

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Interventional Endoscopy: Endoluminal Therapy – Stenting, Clipping, and Suctioning

Hodgens

Bueno

2019

Multidisciplinary Approaches to Common Surgical Problems

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Usefulness of over‐the‐scope clipping system for closing digestive fistulas

Abstract: OTSC placement seems to be safe and effective for the treatment of GI fistulas. Better results were seen in leaks after LSG.

Cited by 100 publications

References 37 publications

Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series

Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series

Successful closure of a chronic vesicorectal fistula after radical prostatectomy with an over-the-scope clip

Interventional Endoscopy: Endoluminal Therapy – Stenting, Clipping, and Suctioning

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