Over-the-scope-clips are safe and effective in the closure of gastrocutaneous fistulas

Aims A rare complication following the removal of a percutaneous endoscopic gastrostomy (PEG) tube is the formation of a gastocutaneous fistula (GF). Although a number of techniques have been described for managing GF, to date there is very little data on the efficacy of over-the-scope clips in treating GF. In this study we aimed to determine the efficacy and safety of over-the-scope clip in the treatment of persistent GF.

Methods A prospectively collected database for consecutive patients treated at a large teriary centre with over-the-scope clip for persistent GF, from September 2016 up until September 2023, was analysed. In all patients the GF tract was first treated with a wire brush before deployment of the over-the-scope clip. Data collected included patient demographics, PEG dwell time before removal, technical success (defined by succesful clip deployment and fistula closure), procedure-related complications and 30 and 90-day clinical success rate, defined as no clinical evidence of a patent fistula on follow-up.

Results Over a 7 year period, a total of 31 GF cases (18 male) were treated with over-the-scope clip. Mean age was 49. Prior to removal, the median PEG dwell time was 16 months. Median procedure time was 14 minutes (range 9-35). Technical success was recorded in 97% of cases. In 3 procedures, ancillary techniques were required. One case was complicated by intraprocedural bleeding, but succesful endoscopic haemostasis was achieved. The clinical success rate at both 30 days and 90 days was 94%, with only two fistulas recurring.

Conclusions This is the largest observational study in the literature to date on the use of over-the-scope clip for the treatment of GF. This study shows that over-the-scope clip is a quick, safe and effective technique to achieve closure of persistent GF.

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Artikel online veröffentlicht:
15. April 2024