Combined endoscopic-percutaneous treatment of upper GI entero-cutaneous fistula using innovative technology

Background and study aims Entero-cutaneous fistulae are rare but difficult complications after gastrointestinal surgical interventions; a small subgroup remains resistant to conventional therapy. We present a case series using an innovative method combining an endoscopic sealing of the orifice with an absorbable plug and transcutaneous suction via endoscopic/ fistuloscopic placed open-pore film (Vac-Plug method).

Patients and methods Retrospective database analysis 2017-2020 of patients with treatment refractory enterocutaneous fistulas. Those patients treated with the new combined technique after 2017 were included in the analysis. Main outcome were clinical success (permanent fistula closure), failures including need for surgical revision, and complications.

Results 14 patients were identified (10 male, mean age 56 years, range 50-74). After a mean of five treatment sessions (range 1-13) over a time period of 23 days (range 4-119), 69 % (9/13) patients showed fistula closure with a median follow-up of 131 days (range 9-1173) thereafter. The remaining cases either had to a short a follow-up after successful closure (n = 1) or were failures (n = 4).

Conclusions The combination of endoscopic plugging and negative-pressure therapy via enterocutaneous fistula orifice appears to be a safe, well-tolerated and effective method in this pilot study on difficult to treat fistulas. Results need to be confirmed by larger multicenter trials.

Publication History

Article published online:
07 September 2021