Fistuloscopy--an adjuvant technique for sealing gastrointestinal fistulae

Endoscopic occlusion of gastrointestinal fistulae can be successfully achieved in a high percentage of patients. In cases where the intestinal opening of the fistula is not accessible, such treatment was hitherto impracticable. Fistuloscopy is a new technique which we have devised, using a flexible endoscope advanced percutaneously along the fistula tract to seal these gastrointestinal fistulae. Eleven out of 17 enterocutaneous fistulae and 5 out of 8 abscesses could be sealed using this technique. The complications in this series were all caused by fibrin glue injection into the fistulae under pressure. One patient died of an air embolism. Provided that elevation of the air pressure in the fistula system is strictly avoided, fistuloscopy is a safe and potent method of occluding gastrointestinal fistulae, which otherwise need prolonged conservative treatment or hazardous surgical intervention.