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Bawa JH, Sulutaura L, Patel NM, Sufi PA, Parmar C. Closure of Gastrocutaneous Fistula Following Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:3658-3668. [PMID: 37804467 DOI: 10.1007/s11695-023-06861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
Gastrocutaneous fistula (GCF) is a devastating complication that can arise after bariatric and metabolic surgery (BMS). This systematic review examines the success rate of closure techniques of GCF. A systematic search was conducted across MEDLINE, Embase and Cochrane databases to identify studies which reported on closure techniques of GCF after BMS in adults. Thirty-three studies (n = 108 patients) were included. Seventeen different techniques were used to close GCF across all studies. The most popular were stents (n = 17), tissue sealants (n = 12) and over-the-scope clips (n = 11). Twenty-one studies used multiple techniques to attempt closure, including endoscopic vacuum therapy and revisional surgery. This systematic review demonstrates current practice focusing on endoscopic methods such as stents and over-the-scope clips, with relative success in closing GCF.
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Affiliation(s)
- Jasmine H Bawa
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Liene Sulutaura
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Nikhil M Patel
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Pratik A Sufi
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Chetan Parmar
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK.
- Barts Health NHS Trust, London, EC1A 7BE, UK.
- Apollo Hospitals Research and Education Foundation, Delhi, 50096, India.
- University College London, Gower St, London, WC1E 6BT, UK.
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Bragança S, Bordalo Ferreira F, Oliveira AM, Nuno Costa M, Horta D. A rare cause of severe esophagitis in an immunocompetent patient - double complication with an endoscopic resolution. Rev Esp Enferm Dig 2023. [PMID: 37882168 DOI: 10.17235/reed.2023.9966/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
A 75-year-old male, without relevant medical history and negative HIV1/2 serology, presented at the emergency department with mixed shock (septic - from pleuroparenchymal origin - and hypovolemic due to upper gastrointestinal bleeding [UGIB]). Thoracoabdominal CT scan showed an esophagopleural fistula (EPF), with a large right pleural effusion (lately known to be compatible with exudate - Light's criteria) and right pneumothorax, without active bleeding. The upper gastrointestinal endoscopy (UGIE) showed a severe esophagitis and, in distal oesophagus, an ulcer with an orifice in the center. Biopsies of the edges of the ulcer were performed. Anatomopathological (AP) studies were negative for viral agents but tissue molecular studies (polymerase chain reaction [PCR]) identified cytomegalovirus (CMV) DNA. Despite no immunosuppression condition was identified, CMV severe esophagitis complicated by EPF with right-side empyema and UGIB was diagnosed. An oesophageal fully covered metal stent (FCMS), with anti-migration system, was left in place during 5-weeks and ganciclovir therapy (5mg/kg/day) was maintained for 21-days. Clinical-analytical, radiological and endoscopic improvement was noticed. No recurrence in the following year of follow-up.
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Affiliation(s)
- Sofia Bragança
- Gastrenterology, Hospital Professor Doutor Fernando Fonseca, 1600-792
| | | | | | | | - David Horta
- Gastrenterology, Hospital Professor Doutor Fernando Fonseca
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Kumaira Fonseca M, Coelho NHV, Manica JLL, Ramblo RR, Spier IE, Seabra AP. Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder. GE Port J Gastroenterol 2023; 30:52-56. [PMID: 37818401 PMCID: PMC10561307 DOI: 10.1159/000526507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/28/2022] [Indexed: 10/12/2023]
Abstract
Introduction Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascular defects, including gastrointestinal (GI) disruptions. Previous case reports have reported similar results with the CSDO Amplatzer™ for the management of GI disruptions following bariatric surgery. However, the use of similar alternative devices for this purpose has not yet been described. Case Presentation This case report presents the first reported use of the Occlutech® CSDO for the treatment of a chronic gastrocutaneous fistula after bariatric revisional surgery. Despite apparent initial success - no extravasation of contrast material through the device in the contrast study after the CSDO placement - fistula closure failed due to partial dislodgement of the device. The placement of a second device between the discs of the former one ultimately sealed the fistulous orifice. Discussion In chronic GI fistulas, the mature tract is often not liable to the application of standard endoscopic methods, leading to failed closure attempts. A new application of Occlutech® CSDO can obviate the clinical burden of a high-risk laparotomy in these cases. Appropriate endoscopic equipment as well as the involvement of a multidisciplinary team are prime conditions to ensure successful patient outcomes.
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Affiliation(s)
| | | | - João Luiz Langer Manica
- Interventional Cardiology in Congenital Heart Disease Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Rafael Ramos Ramblo
- Radiology and Diagnostic Imaging Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Ingrid Elisa Spier
- Critical Care and Internal Medicine Departments, Hospital Moinhos de Vento, Porto Alegre, Brazil
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Garcia R, Gomez Cifuentes JD, Aloor F, Keihanian T, Ryou M, Abidi WM. Closure of refractory gastrocutaneous fistula with endoscopically guided percutaneous suturing with the use of miniature biopsy forceps. VideoGIE 2023; 8:260-262. [PMID: 37456216 PMCID: PMC10339015 DOI: 10.1016/j.vgie.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Video 1Closure of a refractory gastrocutaneous fistula with endoscopically guided percutaneous suturing with the use of miniature biopsy forceps.
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Affiliation(s)
- Rogelio Garcia
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Juan D Gomez Cifuentes
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Fuad Aloor
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Tara Keihanian
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wasif M Abidi
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Muacevic A, Adler JR, Bueno Motter S, Rangel Brandão G, lacava Schramm R, Thomaz Pioner G. Endoscopic Treatment Using the Padlock Clip System for Rectourethral Fistula After Prostatectomy. Cureus 2023; 15:e33250. [PMID: 36741659 PMCID: PMC9891095 DOI: 10.7759/cureus.33250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
We present a case of a 68-year-old man with a rectourethral fistula (RUF) successfully treated with a unique endoscopic approach using the Padlock Clip system (Steris, Basingstoke, UK). This is a complex case of a patient who, after radical prostatectomy, continued to show several complications, including fistulas and relapses. Our work aims to enhance the literature with our technique and to help the scientific community in future RUF cases. Our case stands out because this therapeutic approach has not yet been described in the literature as a possible endoscopic treatment of RUF. Therefore, our topic description is essential to assist future similar cases.
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Zhang J, Da B, Diao Y, Qian X, Wang G, Gu G, Wang Z. Efficacy and safety of over-the-scope clips (OTSC®) for closure of gastrointestinal fistulas less than 2 cm. Surg Endosc 2022; 36:5267-5274. [PMID: 34988734 DOI: 10.1007/s00464-021-08904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Gastrointestinal (GI) fistula is a complication of surgery associated with potential morbidity and mortality. The aim of this study was to evaluate the efficacy and safety of over-the-scope clips (OTSC®) for closing GI fistulas. METHODS Patients with GI fistula who underwent endoscopic closure using OTSC® were enrolled. The clinical date, duration, location and diameter of the fistula, technical success of the OTSC®, complications, follow-up periods and clinical success were recorded. RESULTS A total of 98 patients with GI fistula underwent OTSC® closure. Their median age was 50 years (range 16-88 years), and the median duration of the fistula was 185.5 days (range 12-3129 days). The mean diameter of fistula was 4.64 ± 1.16 mm. Technical success was achieved in 100% of the patients, and clinical success was achieved in 55.10% (54/98) of the patients after a median follow-up of 168.5 days (range 36-424 days). Based on the location of the fistula, the clinical success rate of treating a fistula in the esophagus and small intestine was 100%, followed by the rectum (70%, 7/10), anastomotic stoma (61.90%, 13/21), duodenum (53.33%, 8/15), colon (47.06%, 8/17), stomach (43.47%, 10/23) and appendix stump (33.33%, 2/6). The duration of the fistula (HR 3.609, 95% CI 1.387-9.387, P = 0.009) was a risk factor for clinical success by multivariate analysis. CONCLUSION OTSC® is a safe and efficient treatment for GI fistula and is a potential alternative to the surgical approach. Before OTSC® placement, the duration of the fistula should be assessed since it is related to the successful closures with OTSC®.
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Affiliation(s)
- Juanjuan Zhang
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Binlin Da
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Yanqing Diao
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Xiaoli Qian
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Gefei Wang
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Guosheng Gu
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Zhiming Wang
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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