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DOI: 10.1055/s-0034-1392792
Endoscopic closure of gastrocutaneous leakage with polyglycolic acid sheets
Publikationsverlauf
Publikationsdatum:
14. Oktober 2015 (online)
Gastrointestinal leakage after surgery is not amenable to several forms of conservative management, and reoperation strategies increase the risk for morbidity and mortality [1]. We report a case of successful endoscopic closure of a gastrocutaneous fistula with polyglycolic acid (PGA) sheets (Neoveil; Gunze Medical Division, Kyoto, Japan) and fibrin glue (Beriplast P Combi-Set; CSL Behring Pharma, Tokyo, Japan).
A 68-year-old man who had pancreatic cancer (T4N1M0, stage IVa) underwent neoadjuvant chemoradiotherapy followed by pancreaticoduodenectomy with major arterial resection in the department of surgical oncology of our hospital. Following surgery, gastric juice was observed around a drainage tube just above the gastrojejunal anastomosis. Gastric and subcutaneous pooling of contrast agents and a gastrocutaneous leak were diagnosed radiographically ([Fig. 1]).
Conservative treatment, including the application of cyanoacrylate glue through the skin into the fistula, was ineffective, and leakage with pus continued for 3 months. Therefore, we attempted endoscopic closure with PGA sheets and fibrin glue. First, argon plasma coagulation was used to ablate the mucosa around the fistula, which was located at the lesser curvature of the antrum near the anastomosis ([Fig. 2 a, ] [Fig. 2 b]; [Video 1]). Subsequently, the PGA sheet was cut into small (15 × 8-mm) pieces, and a biopsy forceps through the scope channel was used to fill the fistula with 10 of these pieces ([Fig. 2 c]). Fibrin glue was applied to the PGA sheets, and endoclips were used to gather mucosa around the fistula.
Qualität:
This procedure was repeated 1 week later because the fistula had persisted. At 14 days after the first procedure, the gastrocutaneous leakage had disappeared ([Fig. 3 a]), and the fistula had improved ([Fig. 3 b]). The patient was discharged 1 month after the first procedure.
PGA sheets with fibrin glue have previously been used to close perforations and fistulas [2] [3] [4] [5]. This case suggests that endoscopic closure with PGA sheets and fibrin glue can be used to treat gastrointestinal leakage.
Endoscopy_UCTN_Code_TTT_1AO_2AI