title: Fibrin glue in the endoscopic treatment of fistulae and anastomotic leakages of the gastrointestinal tract.
abstract: BACKGROUND
  Fistulae or leakages of anastomotic junctions of the gastrointestinal tract used to be an indication for surgery. However, patients often are severely ill and endoscopic therapeutic options have been suggested to avoid surgical intervention.
  
  
  OBJECTIVE
  This is a retrospective analysis of fibrin glue application in the treatment of gastrointestinal fistulae or anastomotic leakages.
  
  
  OBJECTIVE
  The aim of this study was to investigate the value of fibrin glue in the treatment of gastrointestinal fistulae and leakages.
  
  
  METHODS
  From September 1996 to November 2002, 52 patients with gastrointestinal fistulae or insufficiencies have been treated endoscopically including the use of fibrin glue (Tissucol Duo S®, Baxter, Unterschleissheim, Germany). Clinical data comprising concomitant therapies and results were analysed by chart review.
  
  
  RESULTS
  Twenty-six lesions were located in the oesophagus or gastroesophageal junction, 4 in the stomach, 7 in the small intestine, 13 colorectal and 2 in the pancreas. The duration of treatment ranged from 12 to 1,765 days. Two to 81 ml fibrin glue (median 8.5) was used in 1-40 sessions (median 4). All patients received antibiotics; additional endoscopic options were frequently applied. Endoscopic therapy cured 55.7% patients (n = 29); 36.5% (n = 19) were cured with fibrin glue as sole endoscopic option. In 23.1% (n = 12), surgical intervention became necessary. Patients without major infectious complications tended to have a higher cure rate without surgery (87.5% vs. 50%). Eleven patients died (21.1%).
  
  
  CONCLUSIONS
  Endoscopic therapy is a valuable option in the treatment of fistulae and anastomotic insufficiencies of the gastrointestinal tract. It usually is applied repeatedly. Fibrin glue is a mainstay of this procedure. Major infectious complications seem to define a subgroup of patients with poorer outcome.
authors.affiliation: Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany. elisabeth.lippert@klinik.uni-regensburg.de
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lippert
authors.forename: Frank H
authors.initials: FH
authors.lastname: Klebl
authors.forename: Florian
authors.initials: F
authors.lastname: Schweller
authors.forename: Claudia
authors.initials: C
authors.lastname: Ott
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Gelbmann
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schölmerich
authors.forename: Esther
authors.initials: E
authors.lastname: Endlicher
authors.forename: Frank
authors.initials: F
authors.lastname: Kullmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000628:therapy*; D003710:Demography; D016154:Digestive System Fistula / Q000150:complications* / Q000628:therapy*; D004724:Endoscopy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive