CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E994-E997
DOI: 10.1055/a-0584-6669
Case report
Owner and Copyright © Georg Thieme Verlag KG 2018

Endoscopic closure of an anastomo-cutaneous fistula: Filling and shielding using polyglycolic acid sheets and fibrin glue with easily deliverable technique

Hideaki Kawabata
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
,
Yuji Okazaki
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
,
Naonori Inoue
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
,
Yukino Kawakatsu
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
,
Misuzu Hitomi
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
,
Masatoshi Miyata
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
,
Shigehiro Motoi
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 24. November 2017

accepted after revision 12. Februar 2018

Publikationsdatum:
03. August 2018 (online)

Abstract

Background and study aims Recently, endoscopic closure of gastrointestinal fistulas using polyglycolic acid (PGA) sheets with fibrin glue (FG) has been attempted. A 70-year-old woman who had undergone pancreaticoduodenectomy for pancreatic cancer suffered from a refractory anastomo-cutaneous fistula at the site of gastro-jejunostomy. We attempted endoscopic closure with filling and shielding using PGA sheets and FG. After introducing a guidewire into the fistula, a small piece of PGA sheet was skewered onto the guidewire and then pushed using a tapered catheter over the guidewire and delivered into the fistula. A total of 10 sheets were delivered via the same procedure. Next, the mucosa around the fistula was ablated, and the orifice of the fistula along with the surrounding mucosa was shielded with a piece of PGA sheet fixed with hemoclips and FG. After this procedure, the leakage disappeared and the fistula was undetectable on contrast radiograms. Endoscopic closure of anastomo-cutaneous fistula with filling and shielding using PGA sheets and FG is an effective, safe, low-invasive treatment, and the filling technique using a guidewire ensures a safe, smooth procedure.