Elsevier

Gastrointestinal Endoscopy

Volume 62, Issue 3, September 2005, Pages 432-435
Gastrointestinal Endoscopy

New Method
Combined endoscopic cautery and clip closure of chronic gastrocutaneous fistulas

https://doi.org/10.1016/j.gie.2005.04.047Get rights and content

Background

Chronic gastrocutaneous fistula with intermittent drainage is a common outcome after removing long-standing gastrostomy tubes. The standard treatment is surgery with laparotomy and excision of the fistula tract. This study describes the results of an endoscopic closure technique by using a combination of electrocautery and metal clips.

Methods

Three patients with gastrocutaneous fistulas (duration 3 months to 3 years) after gastrostomy tube removal were treated endoscopically by electrocautery of the tract and application of metal clips.

Observations

Treatment resulted in complete fistula closure in two patients and partial closure in a third patient.

Conclusions

Combined endoscopic therapy with electrocautery and clipping may be an alternative to surgical closure of chronic gastrocutaneous fistulas.

Section snippets

Patient 1

A girl with epidermolysis bullosa simplex underwent surgical placement of a gastrostomy tube at 1 month of age for supplemental feeding when perioral bullous formation prevented adequate oral feeding. By 1 year of age, the child had improved, no longer requiring supplemental tube feedings, and the gastrostomy tube was removed. The gastrocutaneous fistula continued to drain for the next month, causing maceration of the skin from exposure to gastric contents. The tract was too small to cauterize

Discussion

The endoscopic clipping technique described in this study resulted in complete closure of a chronic gastrocutaneous fistula in two patients and partial closure in a third patient. Several factors may have contributed to incomplete fistula closure in the third patient with the longest established gastrostomy tract. Although cautery of the tract with both silver nitrate and electrocoagulation was used to ablate the epithelial lining of the tract and to promote bridging scar formation, this

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This work was presented, in part, at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, October 2-5, 2003, Montreal, Canada.

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