Abstract
Background and aim
Endoscopic closure of chronic gastrointestinal fistulas (CGFs) is challenging due to their epithelialized surfaces. The aim of this study was to assess the efficacy and long-term closure rate of endosuturing for CGFs with an Apollo Overstitch device.
Patients and methods
Consecutive CGF patients undergoing endosuturing for fistula closure from April 2018 to January 2020 at the First Affiliated Hospital of Nanjing Medical University were enrolled for retrospective review. Demographics, fistula characteristics, details of the suturing procedures and outcomes were collected for analysis.
Results
Twenty patients (mean age 59.8 ± 9.1 years; 85% males) with a total of 23 CGFs underwent sutured fistula closure. Esophagotracheal fistulas were the most common CGFs (12/23, 52.2%), and prior cancer surgery was the most common fistulization etiology (14/20, 70%). Twelve patients (12/20, 60%) had undergone failed endoscopic attempts at fistula closure before suturing. Additional endoscopic therapies used during suturing were 100% argon plasma coagulation, 50% clip fixation, and 10% stent placement. Although all patients undergoing suturing achieved immediate technical success of fistula closure, sustained fistula closure was observed in only 5 patients (5/20, 25.0%) on surveillance endoscopy 3 months after suturing with a mean follow-up of 19.5 months. Esophagotracheal fistula patients were predisposed to shorter dehiscence-free survival than those with other fistulas (HR 3.378; 95% CI 1.127–10.13).
Conclusions
Endosuturing is safe and should be considered for use as the first-line or salvage therapy for CGF closure, primarily for patients with fistulas not involving the trachea. However, the long-term healing of CGFs by suturing is challenging, and CGF patients might not benefit from repeated suturing.
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Authors contribution
D.J. and M.X. analyzed the data and wrote the manuscript; K.H. and L.P. collected the electronic medical records of the enrolled patients; G.Z. performed the endoscopic suturing for fistula patients; X.L. and L.L. assisted the suturing procedures; Y.D. and F.Y. revised the manuscript. All authors approved the final manuscript.
Funding
This study was supported in part by the National Nature Science Foundation of China (No. 81770561, and No. 81970499) and Jiangsu Province Leading Talents and Innovation Team (CXTDA2017033).
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Drs. Jin D, Xu M, Huang K, Peng L, Li X, Li L, Dang Y, Ye F, and Zhang G have no conflicts of interest or financial ties to disclose.
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Jin, D., Xu, M., Huang, K. et al. The efficacy and long-term outcomes of endoscopic full-thickness suturing for chronic gastrointestinal fistulas with an Overstitch device: is it a durable closure?. Surg Endosc 36, 1347–1354 (2022). https://doi.org/10.1007/s00464-021-08412-2
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DOI: https://doi.org/10.1007/s00464-021-08412-2