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Published on: April 17, 2020
Initial results of endoscopic gastrocutaneous fistula closure in children using an over-the-scope clip
Robert Wright1, Claire Abrajano, Raji Koppolu
1Division of Pediatric Surgery, Lucile Packard Children's Hospital , Stanford, California.
Insights
Endoscopic closure of gastrocutaneous fistulas (GCF) using over-the-scope clips is a safe and effective option for pediatric patients. This minimally invasive technique offers excellent functional and cosmetic outcomes, reducing complications and improving patient satisfaction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Endoscopic Interventions
Background:
- Gastrocutaneous fistula (GCF) is a common complication in pediatric patients post-gastrostomy tube removal.
- Traditional open surgical repair, while effective, can lead to incisional complications and prolonged recovery.
- Endoscopic approaches offer potential advantages, especially in cases with skin irritation or patient comorbidities.
Purpose of the Study:
- To evaluate the feasibility and outcomes of endoscopic closure of pediatric GCF using over-the-scope (OSC) clips.
- To assess the safety, efficacy, and patient satisfaction associated with this novel endoscopic technique.
Main Methods:
- A prospective study involving six pediatric patients with GCF.
- Endoscopic closure of GCF using OSC clips under Institutional Review Board approval.
- Evaluation of technical success, operating time, healing at 1 month, postoperative pain, and patient satisfaction.
Main Results:
- Technical success was achieved in 5 out of 6 cases (83.3%).
- Average operating time was 29 minutes, with successful cases performed as outpatients without narcotics.
- All successfully treated patients showed complete GCF healing at 1 month with high satisfaction and excellent cosmetic results.
Conclusions:
- Endoscopic GCF closure with OSC clips is technically feasible and safe in pediatric patients.
- This minimally invasive method provides excellent functional and cosmetic outcomes, serving as a viable alternative to open surgery.
- OSC clip closure is particularly beneficial for patients with perimal GCF skin issues or significant comorbidities.
Abstract:
Gastrocutaneous fistula (GCF) occurs commonly in pediatric patients after removal of long-term gastrostomy tubes. Although open repair is generally successful, endoscopic approaches may offer benefits in terms of incisional complications, postoperative pain, and procedure time. In addition, endoscopic approaches may offer particular benefit in patients with varied degrees of skin irritation or erosion surrounding a GCF, making surgical repair difficult, or patients with significant comorbidities, making minimal intervention and anesthesia time preferable. Over-the-scope (OSC) clips are a new technology that enables endoscopic closure of intestinal fistulas up to 2 cm in diameter. Six pediatric patients underwent endoscopic GCF closure using OSC clips under Institutional Review Board approval. The procedure was technically successful in 5 of 6 cases with an average operating time of 29 minutes. The technical failure required an open revision, whereas all other patients reported full healing of the GCF site at 1 month. All successful cases were performed as outpatients without postoperative narcotics. In addition, all patients reported high satisfaction with the procedure and cosmetic results. Endoscopic GCF closure using an OSC clip is technically feasible in the pediatric population. Based on limited cases with a 1-month follow-up, the functional and cosmetic results of technically successful cases are excellent. Endoscopic GCF closure is a potential alternative to standard surgical closure in patients with skin irritation or erosion and/or significant comorbidities.
