Over-the-scope clip to close a gastrocutaneous fistula after esophagectomy

Over-the-scope clip(OTSC) system is becoming a new reliable technique which is available for the endoscopic closure of fistulas, bleeding, perforations and so on. We describe the case of a patient with a nonhealing gastrocutaneous fistula after esophagectomy for esophageal squamous cell carcinoma which was successfully closed using an OTSC system. This is the first report of the use of OTSC to treat a nonhealing gastrocutaneous fistula successfully after esophagectomy. We believe our experience will give such patients an ideal way to cure the fistula without suffering too much and also explore new application of OTSC.     

Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant

BACKGROUND: Gastrocutaneous fistula is an uncommon and difficult to treat complication that occurs in 0.5% to 3.9% of patients who undergo gastric surgery. Sepsis usually follows, and, when it is not managed effectively, the associated mortality rate can be as high as 85%. A fibrin sealant was used to endoscopically manage gastrocutaneous fistulas that developed in 3 morbidly obese patients after bariatric surgery. METHODS: Two of 14 (14.29%) patients who underwent vertical gastroplasty (MacLean procedure) developed a non-healing gastrocutaneous fistula. In addition, one of 24 (4.17%) patients who had a biliopancreatic diversion with preservation of pylorus developed a gastrocutaneous fistula. Endoscopic application of a fibrin sealant was performed under direct vision via a double-lumen catheter passed through a forward-viewing endoscope. OBSERVATIONS: Treatment was successful in all patients after one or more endoscopic sessions in which the fibrin sealant was applied; no evidence of fistula was found at follow-up endoscopy. CONCLUSIONS: Endoscopic closure of gastrocutaneous fistula with human fibrin tissue sealant is simple, safe, and effective, and, in some cases, can be life-saving. Endoscopic application of fibrin sealant should be considered a therapeutic option for treatment of gastrocutaneous fistula that develops after bariatric surgery.     

Over-the-scope-clip closure of long lasting gastrocutaneous fistula after percutaneous endoscopic gastrostomy tube removal in immunocompromised patients:A single center case series

Over-the-scope-clips(OTSC~?) have been shown to be an effective and safe endoscopic treatment option for the closure of gastrointestinal perforations, leakages and fistulae. Indications for endoscopic OTSC~? treatment have grown in number and also include gastro cutaneous fistula(GCF) after percutaneous endoscopic gastrostomy(PEG) tube removal. Non-healing GCF is a rare complication after removal of PEG tubes and may especially develop in immunosuppressed patients with multiple comorbidities. There is growing evidence in the literature that OTSC~? closure of GCF after PEG tube removal is emerging as an effective, simple and safe endoscopic treatment option. However current evidence is limited to the geriatric population and short standing GCF, while information on closure of long standing GCF after PEG tube removal in a younger population with significant comorbidities is lacking. In this retrospective single-center case-series we report on five patients undergoing OTSC~? closure of chronic GCF after PEG tube removal. Four out of five patients were afflicted with long lasting, symptomatic fistulae. All five patients suffered from chronic disease associated with a catabolic metabolism(cystic fibrosis, chemotherapy for neoplasia, liver cirrhosis). The mean patient age was 43 years. The mean dwell time of PEG tubes in all five patients was 808 d. PEG tube dwell time was shortest in patient 5(21 d). The mean duration from PEG tube removal to fistula closure in patients 1-4 was 360 d(range 144-850 d). The intervention was welltolerated by all patients and no adverse events occured. Successful immediate and long-term fistula closure was accomplished in all five patients. This single center case series is the first to show successful endoscopic OTSC~? closure of long lasting GCF in five consecutive middleaged patients with significant comorbidities. Endoscopic closure of chronic persistent GCF after PEG tube removal using an OTSC~? was achieved in all patients with no immediate or long-term complications. OTSC~? is a promising endoscopic treatment option for this condition with a potentially high immediate and long term success rate in patients with multiple comorbidities.     

Closure of a nonhealing gastrocutaneous fistula using argon plasma coagulation and endoscopic hemoclips

A case in which a gastrocutaneous fistula developed after percutaneous endoscopic gastrostomy tube placement is presented. The fistula was first managed conservatively, then was closed by argon plasma coagulation and hemoclip placement. The patient was observed and was discharged once the gastrocutaneous fistula closed.     

Bronchoesophageal fistula secondary to aspiration of tongue adhesion button in a child with glossoptosis

A newborn boy with obstructive apnea secondary to glossoptosis was treated by securing his tongue to his lower lip. Soon after, the button that served for posterior fixation became detached and was thought to have been evacuated via the digestive tract. Twenty-two months later the infant presented with pneumonia involving the right lower lobe and hemoptysis, causing an acute respiratory distress syndrome (ARDS). After mechanical ventilation was started marked gastric distention was observed. Esophagography and bronchography revealed a fistula between the right main stem bronchus and the esophagus. During surgical repair the plastic fixation button was found in the bronchial orifice of the fistula. Despite surgical correction of the fistula the child died of refractory respiratory failure. Pediatr Pulmonol. 1997; 23:120–122. © 1997 Wiley-Liss, Inc.