Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy - Archive ouverte HAL Access content directly
Journal Articles Endoscopy Year : 2022

Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy

Pierre Lafeuille
  • Function : Author
Timothée Wallenhorst
  • Function : Author
Alexandru Lupu
  • Function : Author
Jérémie Jacques
  • Function : Author
Thomas Lambin
  • Function : Author
Marine Camus
  • Function : Author
Clara Yzet
  • Function : Author
Thierry Ponchon
  • Function : Author
Florian Rostain
  • Function : Author
Jérôme Rivory
  • Function : Author
Mathieu Pioche
  • Function : Author

Abstract

Background Gastrointestinal (GI) fistula is a life-threatening condition and a therapeutic challenge. Endoscopic approaches include mucosal abrasion, clip closure, or stent diversion, with moderate success rates in the long term. We assessed whether fistula endoscopic submucosal dissection with clip closure (FESDC) could lead to complete resolution of fistulas even after failure of previous endoscopic therapy. Methods Patients with GI fistulas, including those with previous failed treatment, were retrospectively included. The primary outcome was long-term (> 3 months) success of fistula healing. Secondary outcomes included technical success, safety, and factors associated with FESDC success. Results 23 patients (13 refractory 57 %) were included. Tight immediate sealing was achieved in 19 patients (83 %; 95 % confidence interval [CI] 61 %–95 %). Long-term closure was achieved in 14 patients (61 %; 95 %CI 39 %–80 %), with median follow-up of 20 months. Complications occurred in two patients (9 %). Previous local malignancy (P = 0.08) and radiotherapy (P = 0.047) were associated with a higher risk of failure. Conclusion This novel FESDC strategy was demonstrated to be safe and feasible for permanent endoscopic closure of GI fistulas. Further studies are warranted to determine the place of this technique in the management of chronic GI fistula.
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Dates and versions

hal-04179672 , version 1 (10-08-2023)

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Pierre Lafeuille, Timothée Wallenhorst, Alexandru Lupu, Jérémie Jacques, Thomas Lambin, et al.. Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy. Endoscopy, 2022, 54 (07), pp.700-705. ⟨10.1055/a-1641-7938⟩. ⟨hal-04179672⟩
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