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.
Fig. 1 Endoscopic views showing: a the displaced over-the-scope (OTS) clip and the fistula orifice; b the fistula orifice after argon plasma coagulation (marked with a guidewire); c the suture cinch and closed fistula.
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 closure of an enterocutaneous fistula using an endoscopic helix tacking system after argon plasma coagulation of the fistula tract.Video 1
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
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