Abstract
Background and study aims Current endoscopic methods of treating gastric fistulas are either too complex or
have high rates of recurrence. We aimed to provide a novel endoscopic method for robust
fistula closure.
Patients and methods This was a single-center, retrospective study of five patients who underwent multi-layer
endoscopic suturing for closing of a chronic fistula (> 4 weeks). Devitalization of
the fistula tract was achieved with argon plasma coagulation, followed by endoscopic
suturing of the fistula. Then, endoscopic suturing of the gastric wall surrounding
the fistula was performed, creating an overlay of healthy gastric mucosa around the
fistula.
Results Technical success (fistula closure on the day of the procedure) was achieved in all
five patients, with no complications. After a median follow up of 5 months (range
2–23 months), there was a 100 % clinical success rate (no fistula recurrence).
Conclusions Our single-operator method of multi-layer endoscopic suturing provides a robust fistula
closure with minimal to no risk of recurrence. In light of limitations of current
fistula closure methods, further investigations are warranted to better define long-term
outcomes with it compared to alternative methods.
