Placement of a gastrostomy tube is a basic procedure involving the creation of a gastrocutaneous
fistula through which a tube or button device is placed. The tube can be removed when
access is no longer required for patients who recover from their disease. The tract
starts to close within the first day and usually closes within 3 days. However, a
fistula may persist in 25% of cases [1]. Surgical closure has been widely replaced by endoscopic techniques. Various techniques
have been described in small patient series: argon plasma coagulation, silver nitrate,
biopsy with forceps, endoscopic submucosal dissection or electrocautery can be used
for de-epithelization of the fistulous tract. Fibrin glue, clips [2], an over-the-scope clip [3], or bands can be used for closure. Nevertheless, simple means are not always effective
and sometimes the combination of mucosal dissection with submucosal closure was described
to be effective after failure of standard treatments [4].
Therefore, we progressively combine those two techniques from the first closure attempt
to improve one-shot success [5]. We report the case of a 37-year-old patient with a persistent gastrocutaneous fistula
8 weeks after gastrostomy removal. We de-epithelialized the fistulous orifice using
a submucosal dissection technique to promote healing and then closed the orifice with
endoscopic suture (SutuArt; Olympus, Tokyo, Japan) ([Fig. 1], [Fig. 2]) using the V-loc wire (Medtronic, Dublin, Ireland) ([Video 1]). The patient was discharged on day 1 without any adverse event and the gastrocutaneous
fistula was completely healed at the 4-month clinical re-evaluation.
Fig. 1 SutuArt needle (Olympus, Tokyo, Japan).
Fig. 2 Endoscopic scissors (Olympus, Tokyo, Japan).
Procedure of endoscopic submucosal dissection combined with endoscopic suture of a
gastrocutaneous fistula after percutaneous endoscopic gastrostomy tube removal.Video
1
We can assume that this technique may be a therapeutic option for refractory gastro-cutaneous
fistulas.
Endoscopy_UCTN_Code_TTT_1AO_2AO
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