Endoscopic sutures for the closure of gastric fistulas

Aims Persistent gastric fistulas are difficult to treat and causes a lot of suffering for the affected patients. Existing endoscopic methods, such as clips rarely work and often traditional surgery is needed to finally close the fistulas. Endoscopic suturing is a new method for closure of various defects in the gastrointestinal tract. So far, however, studies are scarce on endoscopic sutures for the closure of gastric fistulas.

Methods This is a retrospective review of gastric fistulas that were closed with endoscopic sutures at Karolinska University Hospital 2019-2024.

Results In total 16 patients, 7 women and 9 men, underwent closure of gastric fistulas with endoscopic sutures. Six patients had defects after repaired buried bumper due to Duodopa-PEG, six patients had persistent fistula after removal of PEG, two patients had a fistulas after pancreatic surgery, one patients had a persistent fistula after removal of HotAxios stent due to pancreatitis abscess and one patient had a gastrocutaneous fistula after a perforated ulcer. Three patients relapsed. All of them underwent a second round of endoscopic sutures, and one even a third round, but relapsed again, so we refrained from further trials. One of these patients had an awkward location of the fistula right at the pylorus, which made suturing technically difficult. Technical success was achieved in 22 of 22 procedures (100%). Clinical success was achieved in 13 of 16 patients (81%). There were no complications related to the procedures.

Conclusions Endoscopic suturing is a safe and effective method for the closure of gastric fistulas and should be tried before the patient is referred for traditional surgery.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025