Commentary

Chronic gastrointestinal fistulas are challenging to close using surgical, medical, or endoscopic techniques. Recalcitrant fistulas result in patient suffering from malnutrition, secretions, and recurrent infections. Here we discuss three novel methods to close complex, recalcitrant gastrotracheal, rectovaginal, and urethroanal fistulas [1] [2] [3]. Li et al., from China, used cardiologic devices (atrial, ventricular septal, and patent ductus arteriosus occluders) and coils to successfully close thoracogastric airway fistulas [1]. De Cristofaro et al., from France, were able to close a chronic rectovaginal fistula using principles of plastic surgery by creating an excision around the fistula using the endoscopic submucosal dissection (ESD) technique and then closing the fistula using a loop device (mucosal adaptive ring to close endoscopic artificial ulcer [MARCEAU]) [2]. Finally, Lafeuille et al. used a combination of ESD and the novel Sutuart flexible needle-holder with a barbed suture to close a refractory urethroanal fistula [3].

These cases demonstrate the concept of “thinking outside the box,” by importing tools and techniques from other disciplines to interventional gastrointestinal endoscopy, thus expanding the horizons of therapeutic endoscopy. Indeed, the essential therapeutic interventions in gastrointestinal endoscopy originated using the same approach, adapting catheters from radiologists to create biliary stents, the use of needles for hemostasis, and application of the classic Seldinger technique, among many [4] [5] [6] [7].

Publication History

Article published online:
21 December 2023

• References

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