Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1119-6352
Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202005/lookinside/thumbnails/1687_10-1055-a-1119-6352-1.jpg)
Abstract
Background and study aims Esophageal fistulas after esophagectomy are associated with high mortality and poor quality of life. They are sometimes intractable to conservative management and surgery that increases mortality. Few studies have assessed use of polyglycolic acid (PGA) sheets with fibrin glue for esophageal fistulas. We investigated the safety of using PGA sheets with fibrin glue for esophageal fistulas after esophagectomy.
Patients and methods This was a single-center prospective pilot study. Patients who had refractory esophageal fistulas after esophagectomy were included. PGA sheets were filled in the fistula using biopsy forceps. Fibrin glue was applied to the PGA sheets. We repeated the procedure 1 week later. The outcome measures were the incidence of adverse events (AEs) and closure of the fistula.
Results Five patients were assessed. No adverse events were observed. The esophageal fistula was closed with the application of PGA sheets four times in 40 % (2/5) of the cases.
Conclusions PGA sheets with fibrin glue were safe for esophageal fistula closure after esophagectomy and do not involve the risk of AEs.
Publication History
Received: 30 July 2019
Accepted: 23 January 2019
Article published online:
17 April 2020
© 2020. Owner and Copyright ©
© Georg Thieme Verlag KG
Stuttgart · New York
-
References
- 1 Aryaie AH, Singer JL, Fayezizadeh M. et al. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc 2017; 31: 612-617
- 2 Lee DH, Kim HR, Kim SR. et al. Comparison of clinical outcomes after conservative and surgical treatment of isolated anastomotic leaks after esophagectomy for esophageal cancer. Dis Esophagus 2013; 26: 609-615
- 3 Persson S, Rouvelas I, Irino T. et al. Outcomes following the main treatment options in patients with a leaking esophagus: a systematic literature review. Dis Esophagus 2017; 30: 1-10
- 4 Debourdeau A, Gonzalez JM, Dutau H. et al. Endoscopic treatment of nonmalignant tracheoesophageal and bronchoesophageal fistula: results and prognostic factors for its success. Surg Endosc 2019; 33: 549-556
- 5 Kobara H, Mori H, Fujihara S. et al. Outcomes of gastrointestinal defect closure with an over-the-scope clip system in a multicenter experience: An analysis of a successful suction method. World J Gastroenterol 2017; 23: 1645-1656
- 6 Nakano Y, Takao T, Morita Y. et al. Endoscopic plombage with polyglycolic acid sheets and fibrin glue for gastrointestinal fistulas. Surg Endosc 2019; 33: 1795-1801
- 7 Ojima T, Nakamura M, Nakamori M. et al. Endoscopic treatment of esophageal fistulas after esophagectomy with injection of an alpha-cyanoacrylate monomer: a phase II study. Endosc Int Open 2018; 6: E1093-E1099
- 8 Kobara H, Mori H, Nishiyama N. et al. Over-the-scope clip system: A review of 1517 cases over 9 years. J Gastroenterol Hepatol 2019; 34: 22-30
- 9 Matsuura N, Hanaoka N, Ishihara R. et al. Polyglycolic acid sheets for closure of refractory esophago-pulmonary fistula after esophagectomy. Endoscopy 2016; 48 (Suppl. 01) E78-E79
- 10 Tsujii Y, Kato M, Shinzaki S. et al. Polyglycolic acid sheets for repair of refractory esophageal fistula. Endoscopy 2015; 47 (Suppl. 01) E39-E40
- 11 Takimoto K, Hagiwara A. Filling and shielding for postoperative gastric perforations of endoscopic submucosal dissection using polyglycolic acid sheets and fibrin glue. Endosc Int Open 2016; 4: E661-664
- 12 Gurtner GC, Werner S, Barrandon Y. et al. Wound repair and regeneration. Nature 2008; 453: 314-321
- 13 Nagami Y, Shiba M, Arakawa T. Use of PGA Sheets in the endoscopic closure of a perforation after endoscopic submucosal dissection for gastric-tube cancer. Am J Gastroenterol 2016; 111: 768
- 14 Nagami Y, Shiba M, Tominaga K. et al. Endoscopic closure of gastrocutaneous leakage with polyglycolic acid sheets. Endoscopy 2015; 47 (Suppl. 01) E455-456
- 15 Ono H, Takizawa K, Kakushima N. et al. Application of polyglycolic acid sheets for delayed perforation after endoscopic submucosal dissection of early gastric cancer. Endoscopy 2015; 47 (Suppl. 01) E18-E19
- 16 Bemelman WA, Baron TH. Endoscopic management of transmural defects, including leaks, perforations, and fistulae. Gastroenterology 2018; 154: 1938-1946 e1931
- 17 Rodrigues-Pinto E, Repici A, Donatelli G. et al. International multicenter expert survey on endoscopic treatment of upper gastrointestinal anastomotic leaks. Endosc Int Open 2019; 7: E1671-E1682
- 18 Laukoetter MG, Mennigen R, Neumann PA. et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc 2017; 31: 2687-2696