Clinical application of "purse-string suture" under endoscope in the treatment of refractory postoperative intestinal anastomotic fistula.

BACKGROUND

Postoperative intestinal anastomotic fistula (PIAF) remains a challenging complication with suboptimal outcomes under conventional therapies. This study evaluates the safety and efficacy of endoscopic purse-string suturing (EPS) in managing refractory PIAF and identifies prognostic predictors.

METHODS

A retrospective analysis of 55 patients with refractory PIAF treated via EPS (2015-2024) was conducted. Technical success was defined as endoscopic fistula closure, while clinical success required radiologic/endoscopic healing confirmation. Logistic regression models identified risk factors for poor outcomes.

RESULTS

EPS achieved a technical success rate of 87.3% (52/55) and a clinical success rate of 63.6% (35/55). Subgroup analyses revealed no significant differences between in-house and external referrals (clinical: 61.1% vs. 64.9%, P = 0.786; technical: 88.9% vs. 81.1%, P = 0.463). Preoperative ostomy status correlated with higher clinical success (92.3% vs. 54.8%, P = 0.014), though technical success was comparable (92.3% vs. 85.7%, P = 0.533). Multivariate analysis identified delayed intervention (> 2 months post-diagnosis) (OR = 0.027, 95% CI: 0.002-0.410) and Pre-existing anastomotic stricture (OR = 0.43, 95% CI: 0.004-0.507) as independent risk factors for poor prognosis. Complications included anastomotic stricture (3.6%, managed endoscopically) and transient diarrhea (1 case). No mortality or recurrence occurred during 12-month follow-up.

CONCLUSIONS

This study establishes endoscopic purse-string closure as a safe and effective minimally invasive intervention for refractory post-implantation anastomotic fistulas, particularly when implemented during early disease progression. Therapeutic optimization through time-sensitive intervention and selective stoma creation demonstrates significant potential for enhancing clinical outcomes in complex fistula management.