Novel "rendez-vous" technique for persistent gastrocutaneous fistula closure

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Procedures

Background:

• Gastrocutaneous (GC) fistulas are rare complications following percutaneous endoscopic gastrostomy (PEG) tube removal.
• Traditional surgical closure can be invasive, and endoscopic methods like over-the-scope (OTS) clipping may not always succeed.
• Recalcitrant fistulas pose a significant clinical challenge, often necessitating open surgery.

Purpose of the Study:

• To introduce and evaluate a novel "rendezvous" technique for closing persistent gastrocutaneous fistulas.
• To assess the efficacy and safety of this combined endoscopic and surgical approach.
• To provide a less-invasive alternative for patients with difficult-to-treat fistulas.

Main Methods:

• The study involved four patients with persistent GC fistulas after long-term PEG use.
• A "rendezvous" technique combining endoscopic OTS clipping and extraperitoneal surgical excision of the fistula tract was employed.
• This approach aimed to minimize surgical risks while ensuring fistula closure.

Main Results:

• The "rendezvous" technique demonstrated a 100% success rate in closing persistent GC fistulas.
• No immediate adverse events were reported in the treated patients.
• Follow-up showed no recurrences within two years, indicating durable closure.

Conclusions:

• The novel "rendezvous" technique is effective for closing persistent GC fistulas, particularly in comorbid patients requiring long-term PEG.
• This method offers a less-invasive alternative compared to traditional open surgery.
• It achieves higher closure rates than endoscopic clipping alone, addressing a significant clinical need.