Immediate technical and delayed clinical outcome of fistula closure using an over-the-scope clip device

Ryan Law, Louis M. Wong Kee Song, Shayan Irani, Todd H. Baron

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Background and study aims: An over-the-scope clip (OTSC) device was designed for closure of acute perforations, fistulas, leaks, and non-variceal gastrointestinal bleeding. Previous data show a high rate of early fistula closure using the OTSC; however, data on long-term fistula closure are scant. We report our experience using an OTSC for closure of chronic gastrointestinal fistulas. Patients and methods: Retrospective review of all patients, who underwent OTSC placement at Mayo Clinic Rochester and Virginia Mason Medical Center for closure of chronic fistulas from October 2011 to September 2012, was performed. Initial technical success was defined by lack of contrast extravasation immediately after OTSC placement. Delayed success was defined by resolution of the fistula without the need for additional therapies. Recurrent fistula was defined by the recurrence of symptoms and/or re-demonstration of fistula after initial success. Results: Forty-seven unique patients (24 men; mean age 57 ± 14 years) underwent 60 procedures using the OTSC for closure of gastrointestinal fistulas. Fistula locations were: small bowel (n = 18), stomach (n = 16), colo-rectum (n = 10), and esophagus (n = 3). Fistulas related to previous percutaneous endoscopic gastrostomy/jejunostomy (n = 10) or prior bariatric procedure (n = 10) were the most common etiologies. Initial technical success occurred in 42/47 (89 %) index cases; however, 19/41 (46 %) patients developed fistula recurrence at a median of 39 days (IQR 26–86 days). The retained OTSC was present adjacent to the fistula in 16/19 (84 %) at repeat intervention. Patients were followed for a median length of 178 days (IQR 63–326 days), and only 25/47 (53 %) patients demonstrated delayed clinical success using OTSC. Conclusions: Initial technical fistula closure can be achieved using OTSCs. Recurrent fistulas at the same location occur in approximately 50 % of cases despite frequent OTSC clip retention.

Original languageEnglish (US)
Pages (from-to)1781-1786
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume29
Issue number7
DOIs
StatePublished - Jul 19 2015

Keywords

  • Fistula closure
  • Gastrointestinal fistula
  • Over-the-scope clip

ASJC Scopus subject areas

  • Surgery

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