Melmed Gil Y, Kar Saibel, Geft Ivor, Lo Simon K
Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, California 90048, USA.
Gastrointest Endosc. 2009 Sep;70(3):542-5. doi: 10.1016/j.gie.2009.03.027.
Gastrocolonic fistula after percutaneous endoscopic gastrostomy PEG tube placement is an uncommon but serious complication. These fistulous tracts are often fibrotic and frequently require surgical intervention.
To describe a novel endoscopic treatment for gastrocolonic fistula.
Case report.
Inpatient hospital setting.
An 82-year-old woman was seen 1 year after PEG placement with feculent vomiting; imaging studies showed a gastrocolonic fistula. Cardiopulmonary comorbidities posed an unacceptable surgical risk. Endoscopic attempts at fistula closure with hemoclip placement and biodegradable plug were unsuccessful. Total parenteral nutrition resulted in multiple metabolic and infectious complications.
Gastrocolonic fistula closure was performed twice by using cardiac septal defect closure devices. The first closure was achieved by using the Amplatzer double-disk nitinol wire mesh atrial septal defect closure device, which was deployed under endoscopic and fluoroscopic guidance across the fistula tract. The proximal disk was then injected with cyanoacrylate glue to create a watertight seal. The second closure, performed 4 months later after collapse of the initial device, was performed by using the CardioSEAL septal repair implant. This was secured in place with hemoclips and similarly injected with cyanoacrylate glue to create a watertight seal.
Fistula closure, as determined by contrast gastrogram through a PEG tube and gastrograffin enema.
Successful fistula closure was achieved for 4 months after initial device placement. After the second device was placed, the patient remained clinically well until her demise 18 months later from unrelated causes.
These procedures were performed on only one subject.
Successful endoscopic closure of gastrocolonic fistula can be achieved, even with long-standing, fibrotic fistulous tracts by using a novel endoscopic approach.
经皮内镜下胃造口术（PEG）置管后发生胃结肠瘘是一种罕见但严重的并发症。这些瘘管通常纤维化，常需手术干预。
描述一种胃结肠瘘的新型内镜治疗方法。
病例报告。
住院医院环境。
一名82岁女性在PEG置管1年后出现粪性呕吐；影像学检查显示胃结肠瘘。心肺合并症带来了不可接受的手术风险。尝试通过放置止血夹和使用可生物降解塞子进行内镜下瘘管闭合均未成功。全胃肠外营养导致多种代谢和感染并发症。
使用心脏间隔缺损闭合装置对胃结肠瘘进行了两次闭合。第一次闭合是通过使用Amplatzer双盘镍钛合金丝网房间隔缺损闭合装置，在内镜和透视引导下将其穿过瘘管放置。然后向近端盘注射氰基丙烯酸酯胶水以形成水密密封。4个月后，初始装置塌陷，进行了第二次闭合，使用CardioSEAL间隔修复植入物。用止血夹将其固定到位，并同样注射氰基丙烯酸酯胶水以形成水密密封。
通过PEG管造影和泛影葡胺灌肠确定瘘管闭合情况。
首次放置装置后4个月成功实现瘘管闭合。放置第二个装置后，患者临床情况良好，直到18个月后因无关原因死亡。
这些操作仅在一名受试者身上进行。
即使是长期存在的纤维化瘘管，采用新型内镜方法也可成功实现内镜下胃结肠瘘闭合。
