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Endoscopic closure of persistent gastrocutaneous fistula in children
Sandra M Farach1, Paul D Danielson, Daniel T McClenathan
1Division of Pediatric Surgery, All Children's Hospital Outpatient Care Center, All Children's Hospital Johns Hopkins Medicine, 601 5th Street South, Dept 70-6600, 3rd Floor, St. Petersburg, FL, 33701, USA, sfarach1@jhmi.edu.
Insights
Endoscopic closure of pediatric gastrocutaneous fistulas (GCF) using cautery and endoclips is safe but often requires multiple procedures. Some patients may still need surgical intervention for persistent GCF.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
Background:
- Persistent gastrocutaneous fistula (GCF) occurs in up to 44% of pediatric patients after gastrostomy tube removal.
- Effective and minimally invasive treatment options for GCF are needed.
Purpose of the Study:
- To evaluate the outcomes of an endoscopic technique for closing persistent GCF in children.
- The technique involves cautery and endoclip application.
Main Methods:
- Retrospective analysis of 16 pediatric patients treated for GCF between January 2010 and September 2013.
- Endoscopic closure utilized esophagogastroduodenoscopy with fistula track cauterization and gastric mucosa endoclipping.
Main Results:
- Initial successful closure was achieved in 44% (7/16) of patients after one procedure.
- An additional three patients (19%) were successfully closed after a second procedure.
- Four patients (25%) ultimately required surgical closure, and two (13%) had ongoing drainage.
Conclusions:
- Endoscopic closure of pediatric GCF with cautery and endoclips is a safe approach.
- Multiple procedures may be necessary, and surgical intervention remains an option for refractory cases.
- Patient selection and technique refinement could improve success rates.
Purpose:
The incidence of persistent gastrocutaneous fistula (GCF) after removal of gastrostomy tubes in pediatric patients is estimated to be up to 44 %. Our aim was to review the outcomes of GCF closure by an endoscopic technique that utilizes cautery and endoclips.
Methods:
A retrospective analysis of patients who underwent endoscopic treatment for persistent GCF from January 2010 to September 2013 was performed. This technique utilized esophagogastroduodenoscopy with cauterization of the fistula track and endoclipping of the gastric mucosa.
Results:
Sixteen patients underwent endoscopic treatment for persistent GCF. Mean age at time of endoscopy was 7.5 ± 5.5 (1.1-17) years. Gastrostomy tubes were in place for mean of 5.4 ± 5.2 (0.5-14.2) years prior to removal. The average time from gastrostomy tube removal to first endoscopic clipping was 6.7 ± 9 (0.1-28.9) months. Seven patients (44 %) had successful closure after one endoclipping procedure. Six patients underwent a second endoclipping procedure, with three successful closures. Four patients (25 %) required surgical closure for persistent fistulas and 2 (13 %) have continued drainage.
Conclusions:
While endoscopy with cautery and endoclipping proves to be safe, many patients require multiple procedures and may require surgical closure. Patient selection and refinement of this technique may improve outcomes.
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