Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2017; 9(2): 85-90
Published online Feb 16, 2017. doi: 10.4253/wjge.v9.i2.85
Over-the-scope-clip closure of long lasting gastrocutaneous fistula after percutaneous endoscopic gastrostomy tube removal in immunocompromised patients: A single center case series
Henriette Heinrich, Christoph Gubler, Piero V Valli
Henriette Heinrich, Christoph Gubler, Piero V Valli, Division of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland
Author contributions: All the authors contributed to the manuscript.
Institutional review board statement: A general institutional review board statement for the Department of Gastroenterology and Hepatology issued by the Zuerich Ethics comittee was in place for conducting this case series report.
Informed consent statement: Written consent for the endoscopy as well as research with their medical records was obtained from each patient.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christoph Gubler, MD, Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. christoph.gubler@icloud.com
Telephone: +41-44-2553642 Fax: +41-44-2554474
Received: July 5, 2016
Peer-review started: July 12, 2016
First decision: September 9, 2016
Revised: October 8, 2016
Accepted: November 21, 2016
Article in press: November 22, 2016
Published online: February 16, 2017
Abstract

Over-the-scope-clips (OTSC®) have been shown to be an effective and safe endoscopic treatment option for the closure of gastrointestinal perforations, leakages and fistulae. Indications for endoscopic OTSC® treatment have grown in number and also include gastro cutaneous fistula (GCF) after percutaneous endoscopic gastrostomy (PEG) tube removal. Non-healing GCF is a rare complication after removal of PEG tubes and may especially develop in immunosuppressed patients with multiple comorbidities. There is growing evidence in the literature that OTSC® closure of GCF after PEG tube removal is emerging as an effective, simple and safe endoscopic treatment option. However current evidence is limited to the geriatric population and short standing GCF, while information on closure of long standing GCF after PEG tube removal in a younger population with significant comorbidities is lacking. In this retrospective single-center case-series we report on five patients undergoing OTSC® closure of chronic GCF after PEG tube removal. Four out of five patients were afflicted with long lasting, symptomatic fistulae. All five patients suffered from chronic disease associated with a catabolic metabolism (cystic fibrosis, chemotherapy for neoplasia, liver cirrhosis). The mean patient age was 43 years. The mean dwell time of PEG tubes in all five patients was 808 d. PEG tube dwell time was shortest in patient 5 (21 d). The mean duration from PEG tube removal to fistula closure in patients 1-4 was 360 d (range 144-850 d). The intervention was well tolerated by all patients and no adverse events occured. Successful immediate and long-term fistula closure was accomplished in all five patients. This single center case series is the first to show successful endoscopic OTSC® closure of long lasting GCF in five consecutive middle-aged patients with significant comorbidities. Endoscopic closure of chronic persistent GCF after PEG tube removal using an OTSC® was achieved in all patients with no immediate or long-term complications. OTSC® is a promising endoscopic treatment option for this condition with a potentially high immediate and long term success rate in patients with multiple comorbidities.

Keywords: Gastro cutaneous fistula, Endoscopic fistula closure, Over-the-scope-clips, Percutaneous endoscopic gastrostomy, Fistula in immmunosuppressed patients

Core tip: Over-the-scope-clips (OTSC®) are effective and safe for closure of gastrointestinal perforations, leakages and fistulae. There is growing evidence that OTSC® can be applied for the closure of gastro-cutaneous fistula after percutaneous endoscopic gastrostomy (PEG) tube removal. In this retrospective single-center case-series we report on five middle-aged patients with multiple comorbidities undergoing OTSC® closure of chronic gastro cutaneous fistula after PEG tube removal. The mean dwell time of PEG tubes was 808 d. Successful immediate and long-term fistula closure was accomplished in all five patients. OTSC® is a promising treatment for this condition with a high immediate and long-term success rate.