Endoscopic submucosal dissection combined with endoscopic closure of gastrointestinal fistulas, including those refractory to previous treatment: results after descriptive series (with video) - 28/11/25
, Pierre Lafeuille, MD 2, Jérémie Jacques, MD, PhD 3, Timothée Wallenhorst, MD 4, Florian Rostain, MD 2, Alexandru Lupu, MD 2, Jérôme Rivory, MD 2, Mathieu Pioche, MD, PhD 2Abstract |
Background and Aims |
Several endoscopic techniques are available for the closure of fistulas, but reported long-term efficacy is disappointing. Endoscopic submucosal dissection combined with endoscopic closure showed promising results. We evaluated the results of this combined technique in a larger number of consecutive patients.
Methods |
Patients with GI fistulas, including those with previous failed treatment, were retrospectively included. During the procedure, injection and circumferential incision around the fistulous hole was performed, followed by dissection of the fistulous track as deep as possible, creating a mucosal flap. The flap was finally removed and the edges closed using several closure devices. The primary outcome was long-term (>3 months) success of fistula healing. Secondary outcomes included technical success, safety, and factors associated with success. To evaluate risk factors for long-term failure, patients treated in our previous descriptive study were included in the univariable analysis.
Results |
We included 32 patients (66% refractory) in the present study. Technical success was 78%. In total, 28 of 32 (88%) patients completed > 3 months follow-up. Among them, 43% (12/28) achieved long-term closure with 8 months median follow-up (IQR, 5-18). In treatment-naïve patients, technical success rate was 91% (10/11) and long-term closure was 78% (7/9). Adverse events occurred in 3 patients (9%). Risk factors for long-term failure were evaluated in 51 patients (23 previously treated in our first descriptive study and 28 patients with complete follow-up from the present evaluation). Age ( P = .01), surgical ( P = .007), or oncologic origin ( P = .001) and previous treatment attempts ( P = .007) were significantly associated with failure.
Conclusions |
Endoscopic submucosal dissection with closure is safe and effective to cure fistulas and could be considered part of the first-line treatment for treatment-naïve patients. In patients refractory to treatment, although of moderate efficacy, this technique could represent an alternative approach before salvage surgery.
Le texte complet de cet article est disponible en PDF.Abbreviations : APC, ESD, FESDC, OTS
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