Sleiman Joelle, Abureesh Mohammad, Kumar Vishnu Charan Suresh, Elfiky Ahmed, Chalhoub Jean M, Andrawes Sherif, El Douaihy Youssef
Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
VideoGIE. 2025 Apr 8;10(9):487-492. doi: 10.1016/j.vgie.2025.04.003. eCollection 2025 Sep.
Endoscopic therapies are currently the mainstay of treatment for GI fistulas. However, some GI fistulas are hard to treat as the result of the tissue's friability and large size defect. This case series describes a novel technique for managing hard-to-treat fistulas.
Using an endosuturing device, we strategically obtain full-thickness bites at various points around the fistula opening. After each bite, the anchor is released, and a new suture thread is loaded into the suturing device for another bite at a different point. These sutures are intentionally left untightened, remaining loose within the GI tract. Subsequently, the scope is withdrawn, leaving the sutures extending outside the patient. In using a dual-channel scope, we mount an over-the-scope clip on the scope, and the suture threads are captured through one of the scope channels using a snare. The endoscope is reintroduced. Traction is then applied to the suture threads, allowing healthy tissue to be drawn outside the fistula, forming a flap. Once enough tissue is pulled inside the over-the-scope cap, the clip is deployed, creating an occlusive patch and effectively sealing the fistulous tract.
We present 3 cases of GI fistulas that failed to close using traditional endoscopic techniques. The first case is that of a 78-year-old man with a history of bladder cancer treated with radical cystectomy and neobladder construction, as well as a long history of ulcerative colitis resulting in a rectovesicular fistula. The second case is of a 68-year-old man with a history of gastric cancer treated with partial gastrectomy and gastrojejunostomy complicated by jejunocolonic fistula formation. The third patient is a 30-year-old man with a history of cerebral palsy who relies on enteral feeding via jejunostomy, with gastrocutaneous fistula formation at the previous gastrostomy tube site.
We presented 3 successful applications of this novel technique, each with a 9- to 13-month follow-up showing no recurrence or adverse events. This technique offers a promising solution for challenging fistulas that resist closure with standard procedures.
内镜治疗目前是胃肠道瘘治疗的主要手段。然而，由于组织脆弱和存在大尺寸缺损，一些胃肠道瘘难以治疗。本病例系列描述了一种治疗难治性瘘的新技术。
使用内镜缝合装置，我们在瘘口周围的不同点有策略地进行全层咬合。每次咬合后，释放锚定器，并将新的缝合线装入缝合装置，以便在不同点进行另一次咬合。这些缝线故意不收紧，在胃肠道内保持松弛。随后，撤出内镜，使缝线延伸到患者体外。在使用双通道内镜时，我们在内镜上安装一个套扎器，并用圈套器通过其中一个内镜通道捕获缝合线。重新插入内镜。然后对缝合线施加牵引力，使健康组织被拉到瘘口外，形成一个皮瓣。一旦有足够的组织被拉入围套器帽内，就释放夹子，形成一个封闭补丁，有效地封闭瘘管。
我们展示了3例使用传统内镜技术未能闭合的胃肠道瘘病例。第一例是一名78岁男性，有膀胱癌根治性膀胱切除术和新膀胱构建病史，以及长期溃疡性结肠炎病史，导致直肠膀胱瘘。第二例是一名68岁男性，有胃癌部分胃切除术和胃空肠吻合术病史，并发空肠结肠瘘形成。第三例患者是一名30岁男性，有脑瘫病史，依靠空肠造口进行肠内喂养，在先前胃造瘘管部位形成胃皮肤瘘。
我们展示了这项新技术的3次成功应用，每次随访9至13个月均未出现复发或不良事件。这项技术为那些难以用标准程序闭合的具有挑战性的瘘提供了一个有前景的解决方案。
