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DOI: 10.1055/a-2503-5984
Endoscopic suture-based closure of an enterocutaneous fistula after one-anastomosis gastric bypass
Gastrointestinal cutaneous fistulas are complex and challenging surgical conditions that occur predominantly postoperatively [1]. Effective treatment requires a multidisciplinary approach, with surgical revision carefully planned and typically considered after the failure of conservative treatments [2]. Endoscopic therapies, including clipping and vacuum therapy, along with newly developed endoscopic suture-based techniques, have shown promising results in closing fistulas without the high morbidity and mortality of surgical interventions [3] [4] [5].
We present the case of a 64-year-old man who developed an enterocutaneous fistula following a laparoscopic one-anastomosis gastric bypass for morbid obesity. His postoperative course was complicated by perforation at the biliopancreatic limb. After two unsuccessful attempts at permanent closure surgically and a subsequent subcutaneous infection, an enterocutaneous fistula developed. A temporary fistula closure was achieved using an over-the-scope (OTS) clip but, after displacement of the clip ([Fig. 1] a), the fistula persisted.
Endoscopic fistula closure was performed 10 months postoperatively. This was carried out using an endoscopic helix tacking system (X-Tack; Boston Scientific Corporation, Marlborough, Massachusetts, USA) after argon plasma coagulation of the fistula tract had been performed ([Fig. 1] b,c; [Video 1]), and was followed by placement of an external suture to close the cutaneous opening of the fistula. The patient’s postinterventional course was uneventful. At follow-up after 2 months, no recurrence of the fistula was detected.
Qualität:
Endoscopic enterocutaneous fistula closure is safe and feasible after failed surgery. Novel endoscopic suturing devices extend the possibilities for a tailored approach regarding different locations and types of fistula.
Endoscopy_UCTN_Code_TTT_1AO_2AZ
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
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Publikationsverlauf
Artikel online veröffentlicht:
14. Januar 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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References
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- 2 Gribovskaja-Rupp I, Melton GB. Enterocutaneous fistula: proven strategies and updates. Clin Colon Rectal Surg 2016; 29: 130-137
- 3 Roy J, Sims K, Rider P. et al. Endoscopic technique for closure of enterocutaneous fistulas. Surg Endosc 2019; 33: 3464-3468
- 4 Kantowski M, Karstens K, Scognamiglio P. et al. Combined endoscopic-percutaneous treatment of upper gastrointestinal enterocutaneous fistula using vacuum therapy and resorbable plug insertion (Vac-Plug). Sci Rep 2022; 12: 12221
- 5 Akavia L, Dotan I, Aguila G. et al. A novel endoscopic technique for closure of two gastro-gastric fistulas in a single session using an endoscopic helix tacking device. Endoscopy 2022; 54: E845-E846