Background and study aims
Gastrointestinal (GI) fistulas arise as adverse events of GI surgery and endoscopic treatment as well as secondary to underlying diseases, such as ulceration and pancreatitis. Until a decade ago, they were mainly treated surgically or conservatively. Bioabsorbable polyglycolic acid (PGA) sheets and fibrin glue, which are commonly used in surgical procedures, have also recently been used in endoscopic procedures for the closure of GI defects. However, there have only been few case reports about successful experiences with this approach. There have not been any case-series studies investigating the strengths and weaknesses of such PGA sheet-based treatment. In this study, we evaluated the clinical effectiveness of using PGA sheets to close GI fistulas.
Patients and methods
Cases in which patients underwent endoscopic filling with PGA sheets and fibrin glue for GI fistulas at Kobe University Hospital between January 2013 and April 2018 were retrospectively reviewed.
A total of 10 cases were enrolled. They included fistulas due to leakage after GI surgery, aortoesophageal/bronchoesophageal fistulas caused by chemoradiotherapy, or severe acute pancreatitis. The fistulas were successfully closed in 7 cases (70%). The unsuccessful cases involved a fistula due to leakage after surgical esophagectomy and bronchoesophageal fistulas due to chemoradiotherapy or severe acute pancreatitis. Unsuccessful treatment was related to fistula epithelization.
Endoscopic plombage with PGA sheets and fibrin glue could be a promising therapeutic option for GI fistulas.
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Dr. Nakano, Dr. Takao, Dr. Morita, Dr. Sakaguchi, Dr. Tanaka, Dr. Ishida, Dr. Toyonaga, Dr. Umegaki, and Dr. Kodama have no conflicts of interest to disclose.
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Nakano, Y., Takao, T., Morita, Y. et al. Endoscopic plombage with polyglycolic acid sheets and fibrin glue for gastrointestinal fistulas. Surg Endosc 33, 1795–1801 (2019). https://doi.org/10.1007/s00464-018-6454-z
- Polyglycolic acid sheet
- Fibrin glue