[Endoscopic sclerosis with pneumatic distension for pyriform sinus fistula treatment].
Classic treatment for pyriform sinus fistula (PSF) has been surgical excision; however, less invasive therapeutic alternatives whose aim is the obliteration of the sinus have been described subsequently. The authors present a technical modification of endoscopic sclerosis with diathermy (ESD): continuous infusion of air flow through the flexible endoscope was used to distend the pyriform sinus and facilitate recognition of the fistula opening. The sinus obliteration was performed with a wire guide and diathermy. In the last 15 years, 9 patients were diagnosed of suffering from PSF in our institution. Initial treatment was antibiotics therapy associated in some cases to cervical abscess drainage. Fistulectomy was performed in 4 cases and ESD in 4. The ninth patient received both treatments, performing electrocauterization after a surgical recurrence. Three of the patients who underwent surgery relapsed; none treated by ESD did, or had any complications. In our experience, endoscopic sclerosis with pneumatic distension is a simple technique, reproducible, not invasive and very effective; hence we consider it might become a first line therapy for PSF.
G
G
Sanchís Blanco
C
C
Gutiérrez San Román
M
M
Bordallo Vázquez
J
J
Cortés Sáez
J E
JE
Barrios Fontoba
J
J
Lluna González
M J
MJ
Esteban Ricós
J J
JJ
Vila Carbó
D000038:Abscess; D002648:Child; D002675:Child, Preschool; D003972:Diathermy / Q000379:methods*; D004106:Dilatation / Q000379:methods; D004564:Electrocoagulation / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005402:Fistula / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D056144:Pyriform Sinus / Q000002:abnormalities*; D012008:Recurrence; D015203:Reproducibility of Results