title: Percutaneous endoscopic suturing: an effective treatment for gastrocutaneous fistula.
abstract: BACKGROUND
  Development of persistent gastrocutaneous fistula and leakage after the removal of a PEG tube is a well-known complication. Various treatments including medications to alter gastric pH, prokinetic agents, endoscopic clipping/suturing, electric and chemical cauterization, argon plasma coagulation, and fibrin sealant, have been used with variable success. Although surgical closure is the current treatment of choice, most of the elderly patients are poor surgical candidates because of multiple comorbid conditions.
  
  
  OBJECTIVE
  We describe a method of endoscopic suturing of a gastrocutaneous fistula that is a safe and cost-effective alternative to surgical closure.
  
  
  METHODS
  Individual case.
  
  
  METHODS
  Community hospital.
  
  
  METHODS
  One elderly patient.
  
  
  METHODS
  By using a trocar, we placed multiple, long monofilament sutures from the skin around the gastrocutaneous fistula in criss-cross fashion. Gastric ends of these sutures were pulled from the stomach with a snare under endoscopic visualization. Suture knots were made at the gastric end of the sutures and then were pulled back from the cutaneous side. Multiple biopsy specimens were obtained from both ends of the fistula to promote granulation tissue. Final knots were made at skin level to obliterate the fistula.
  
  
  RESULTS
  Our procedure resulted in complete closure of a large, persistently leaking gastrocutaneous fistula in an elderly patient within 7 days. The patient tolerated the optimal rate of enteral nutrition without further leakage.
  
  
  CONCLUSIONS
  Only 1 patient.
  
  
  CONCLUSIONS
  We believe that this method of endoscopic suturing along with de-epithelialization of the fistula tract for persistent gastrocutaneous fistula is a safe and cost-effective alternative to surgical closure.
authors: Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA.
authors: Saphwat
authors: S
authors: Eskaros
authors: Vishal
authors: V
authors: Ghevariya
authors: Mahesh
authors: M
authors: Krishnaiah
authors: Armand
authors: A
authors: Asarian
authors: Sury
authors: S
authors: Anand
mesh_terms: D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy / Q000191:economics; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D013270:Stomach / Q000601:surgery; D013536:Suture Techniques / Q000191:economics; D016896:Treatment Outcome