Percutaneous endoscopic suturing: an effective treatment for gastrocutaneous fistula - 23/08/11
Reprint requests: Vishal Ghevariya, MD, 240 Willoughby Street, 4C, Brooklyn, NY 11201.Brooklyn, New York, USA
Abstract |
Background |
Development of persistent gastrocutaneous fistula and leakage after the removal of a PEG tube is a well-known complication. Various treatments including medications to alter gastric pH, prokinetic agents, endoscopic clipping/suturing, electric and chemical cauterization, argon plasma coagulation, and fibrin sealant, have been used with variable success. Although surgical closure is the current treatment of choice, most of the elderly patients are poor surgical candidates because of multiple comorbid conditions.
Objective |
We describe a method of endoscopic suturing of a gastrocutaneous fistula that is a safe and cost-effective alternative to surgical closure.
Design |
Individual case.
Setting |
Community hospital.
Patient |
One elderly patient.
Interventions |
By using a trocar, we placed multiple, long monofilament sutures from the skin around the gastrocutaneous fistula in criss-cross fashion. Gastric ends of these sutures were pulled from the stomach with a snare under endoscopic visualization. Suture knots were made at the gastric end of the sutures and then were pulled back from the cutaneous side. Multiple biopsy specimens were obtained from both ends of the fistula to promote granulation tissue. Final knots were made at skin level to obliterate the fistula.
Result |
Our procedure resulted in complete closure of a large, persistently leaking gastrocutaneous fistula in an elderly patient within 7 days. The patient tolerated the optimal rate of enteral nutrition without further leakage.
Limitation |
Only 1 patient.
Conclusion |
We believe that this method of endoscopic suturing along with de-epithelialization of the fistula tract for persistent gastrocutaneous fistula is a safe and cost-effective alternative to surgical closure.
Le texte complet de cet article est disponible en PDF.Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 70 - N° 4
P. 768-771 - octobre 2009 Retour au numéro
Article précédent
- The role of the endoscopist in a multidisciplinary obesity center
- Christopher S. Huang
- Combined endoscopic stent-in-stent placement for malignant biliary and duodenal obstruction by using a new duodenal metal stent (with videos)
- Jong Ho Moon, Hyun Jong Choi, Bong Min Ko, Hyun Cheol Koo, Su Jin Hong, Young Koog Cheon, Young Deok Cho, Moon Sung Lee, Chan Sup Shim
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?