Jovani Manol, Zhang Linda, Huang Yuting, Kumbhari Vivek
Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Gastroenterology and Hepatology, Mayo Clinic, Florida, United States.
Endosc Int Open. 2021 Sep 16;9(10):E1520-E1523. doi: 10.1055/a-1517-4405. eCollection 2021 Oct.
Current endoscopic methods of treating gastric fistulas are either too complex or have high rates of recurrence. We aimed to provide a novel endoscopic method for robust fistula closure. This was a single-center, retrospective study of five patients who underwent multi-layer endoscopic suturing for closing of a chronic fistula (> 4 weeks). Devitalization of the fistula tract was achieved with argon plasma coagulation, followed by endoscopic suturing of the fistula. Then, endoscopic suturing of the gastric wall surrounding the fistula was performed, creating an overlay of healthy gastric mucosa around the fistula. Technical success (fistula closure on the day of the procedure) was achieved in all five patients, with no complications. After a median follow up of 5 months (range 2-23 months), there was a 100 % clinical success rate (no fistula recurrence). Our single-operator method of multi-layer endoscopic suturing provides a robust fistula closure with minimal to no risk of recurrence. In light of limitations of current fistula closure methods, further investigations are warranted to better define long-term outcomes with it compared to alternative methods.
目前治疗胃瘘的内镜方法要么过于复杂，要么复发率很高。我们旨在提供一种新的内镜方法来牢固地闭合瘘管。 这是一项单中心回顾性研究，研究对象为5例接受多层内镜缝合以闭合慢性瘘管（>4周）的患者。通过氩等离子体凝固使瘘管失活，然后对瘘管进行内镜缝合。接着，对瘘管周围的胃壁进行内镜缝合，在瘘管周围形成一层健康的胃黏膜覆盖层。 所有5例患者均取得技术成功（手术当天瘘管闭合），无并发症。中位随访5个月（范围2 - 23个月）后，临床成功率为100%（无瘘管复发）。 我们的单操作者多层内镜缝合方法能牢固地闭合瘘管，复发风险极小或无复发风险。鉴于目前瘘管闭合方法的局限性，有必要进行进一步研究，以更好地确定与其他方法相比其长期疗效。
