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Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study
Saurabh Mukewar1, Nitin Kumar2, Marc Catalano3
1Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Endoscopic suturing offers a safe and effective method for closing gastrointestinal fistulas, including challenging gastrogastric cases. This technique demonstrates high immediate success rates and potential for long-term closure, even after previous failed attempts.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastrointestinal fistulas, particularly gastrogastric fistulas, present a significant challenge for endoscopic closure.
- Existing closure methods often have limitations, necessitating advanced techniques.
Purpose of the Study:
- To evaluate the success rate of endoscopic suturing for gastrointestinal fistula closure.
- To assess the safety and efficacy of this technique, especially in complex cases.
Main Methods:
- A retrospective review of electronic records from three medical centers was conducted.
- Data from 56 patients undergoing sutured fistula closure were analyzed, including demographics and procedural details.
Main Results:
- Endoscopic suturing achieved 100% immediate success in closing fistulas.
- Gastrogastric fistulas were the most common type (51.8%).
- 100% immediate success was achieved in all 56 patients, including those with prior failed closure attempts.
Conclusions:
- Endoscopic suturing is a safe and effective single-session treatment for gastrointestinal fistulas.
- The technique shows promise for challenging cases and offers potential for long-term success with sequential treatments for recurrences.
Abstract:
Background and aim: Endoscopic closure of fistulas is desirable but remains a challenge, especially for gastrogastric fistulas. The aim of this study was to assess the success rate for the closure of gastrointestinal fistulas using an endoscopic suturing device. Patients and methods: Electronic records at three medical centers were reviewed to identify patients who underwent sutured fistula closure as recorded on a central database. Demographic details, clinical variables, and details of the endoscopic procedure were recorded. Results: A total of 56 patients (mean age 54 ± 12.7 years) underwent fistula closure. Gastrogastric fistulas were most common (n = 29; 51.8 %). Sixteen patients (28.6 %) had undergone previous failed attempts at closure. Immediate success was universal (n = 56; 100 %). Thirteen patients had persistent closure without any need for further therapies, while 17 underwent additional endoscopic procedures, with successful closure in 4 /17. Only one patient had abdominal pain requiring hospital admission. Conclusion: Sutured closure of fistulas in a single session is safe and can be expected, even in what are known to be challenging cases. Sequential closure for recurrences is sometimes successful in the longer term.
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