title: Initial results of endoscopic gastrocutaneous fistula closure in children using an over-the-scope clip.
abstract: Gastrocutaneous fistula (GCF) occurs commonly in pediatric patients after removal of long-term gastrostomy tubes. Although open repair is generally successful, endoscopic approaches may offer benefits in terms of incisional complications, postoperative pain, and procedure time. In addition, endoscopic approaches may offer particular benefit in patients with varied degrees of skin irritation or erosion surrounding a GCF, making surgical repair difficult, or patients with significant comorbidities, making minimal intervention and anesthesia time preferable. Over-the-scope (OSC) clips are a new technology that enables endoscopic closure of intestinal fistulas up to 2 cm in diameter. Six pediatric patients underwent endoscopic GCF closure using OSC clips under Institutional Review Board approval. The procedure was technically successful in 5 of 6 cases with an average operating time of 29 minutes. The technical failure required an open revision, whereas all other patients reported full healing of the GCF site at 1 month. All successful cases were performed as outpatients without postoperative narcotics. In addition, all patients reported high satisfaction with the procedure and cosmetic results. Endoscopic GCF closure using an OSC clip is technically feasible in the pediatric population. Based on limited cases with a 1-month follow-up, the functional and cosmetic results of technically successful cases are excellent. Endoscopic GCF closure is a potential alternative to standard surgical closure in patients with skin irritation or erosion and/or significant comorbidities.
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital , Stanford, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Wright
authors.forename: Claire
authors.initials: C
authors.lastname: Abrajano
authors.forename: Raji
authors.initials: R
authors.lastname: Koppolu
authors.forename: Megan
authors.initials: M
authors.lastname: Stevens
authors.forename: Sarah
authors.initials: S
authors.lastname: Nyznyk
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chao
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
authors.forename: James
authors.initials: J
authors.lastname: Wall
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005747:Gastric Fistula / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D061646:Operative Time; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult