title: Endoscopic closure of persistent gastrocutaneous fistula in children.
abstract: OBJECTIVE
  The incidence of persistent gastrocutaneous fistula (GCF) after removal of gastrostomy tubes in pediatric patients is estimated to be up to 44 %. Our aim was to review the outcomes of GCF closure by an endoscopic technique that utilizes cautery and endoclips.
  
  
  METHODS
  A retrospective analysis of patients who underwent endoscopic treatment for persistent GCF from January 2010 to September 2013 was performed. This technique utilized esophagogastroduodenoscopy with cauterization of the fistula track and endoclipping of the gastric mucosa.
  
  
  RESULTS
  Sixteen patients underwent endoscopic treatment for persistent GCF. Mean age at time of endoscopy was 7.5 ± 5.5 (1.1-17) years. Gastrostomy tubes were in place for mean of 5.4 ± 5.2 (0.5-14.2) years prior to removal. The average time from gastrostomy tube removal to first endoscopic clipping was 6.7 ± 9 (0.1-28.9) months. Seven patients (44 %) had successful closure after one endoclipping procedure. Six patients underwent a second endoclipping procedure, with three successful closures. Four patients (25 %) required surgical closure for persistent fistulas and 2 (13 %) have continued drainage.
  
  
  CONCLUSIONS
  While endoscopy with cautery and endoclipping proves to be safe, many patients require multiple procedures and may require surgical closure. Patient selection and refinement of this technique may improve outcomes.
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Outpatient Care Center, All Children's Hospital Johns Hopkins Medicine, 601 5th Street South, Dept 70-6600, 3rd Floor, St. Petersburg, FL, 33701, USA, sfarach1@jhmi.edu.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Farach
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.forename: Daniel T
authors.initials: DT
authors.lastname: McClenathan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wilsey
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
mesh_terms: D000293:Adolescent; D002425:Cautery / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000601:surgery*; D004322:Drainage; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005747:Gastric Fistula / Q000601:surgery*; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome