Endoscopy 2004; 36(4): 337-341
DOI: 10.1055/s-2004-814412
Case Report
© Georg Thieme Verlag Stuttgart · New York

Fibrin Glue as Adjuvant Treatment for Gastrocutaneous Fistula after Gastrostomy Tube Removal

A.  González-Ojeda1 , J.  Avalos-González1 , M.  I.  Muciño-Hernández1 , A.  López-Ortega1 , C.  Fuentes-Orozco1 , M.  Sánchez-Hochoa1 , R.  Anaya-Prado1 , H.  Arenas-Márquez2
  • 1Medical Research Unit in Clinical Epidemiology. Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
  • 2Clinic for Specialized Surgical and Nutritional Clinic, Guadalajara, Jalisco, Mexico
Weitere Informationen

Publikationsverlauf

Submitted 28 January 2003

Accepted after revision 5 August 2003

Publikationsdatum:
01. April 2004 (online)

Preview

Gastrocutaneous fistulas are infrequent after gastrostomy tube removal. However, if the fistulous tract remains permeable, even low-volume output can produce significant cutaneous burns. The use of biodegradable adhesives has been described, where fibrin glue is applied directly over the fistulous tract or under the guidance of procedures such as upper or lower gastrointestinal endoscopy or fistuloscopy. We studied the use of fibrin glue in five consecutive adult patients with gastrocutaneous fistulas after gastrostomy tube removal, with no complications that might impede spontaneous closure. A comparison group included seven patients treated during the preceding 2 years with conservative medical management, who were not treated with fibrin glue. There was no difference between the two groups with regard to age and gender, nor with regard to type of gastrostomy (surgical or endoscopic). The mean output volume from the fistulas was 151.4 ± 146.1 ml/24 h in the study group and 115.0 ± 42.7 ml/24 h in the control group, which was not significantly different (P = 0.80). The duration of previous conservative treatment was 93.8 ± 85.1 days for the study group and 95.8 ± 80.7 days for the control group and this also did not differ significantly (P = 0.93). The time to achieve total fistula closure was 7.0 ± 3.1 days in the study group and 32.7 ± 15.7 days in the control group. This difference was statistically significant (P < 0.004). The time required before oral feeding could be recommenced after spontaneous or induced closure was similar in the two groups, at 2.8 ± 1.3 days and 4.71 ± 2.36 days, respectively. Endoscopic guidance allows direct instillation of fibrin glue via the external opening through the whole fistulous tract. This procedure reduces the time required for the closure of gastrocutaneous fistulas.

References

A. González-Ojeda,M. D. 

Medical Research Unit in Clinical Epidemiology, Western Medical Center, Mexican Institute of Social Security

Av. México #2819, PB · 44690 Guadalajara · Jalisco · Mexico·

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