title: Results of endoscopic and surgical fistula treatment in oesophagointestinal anastomosis after gastrectomy.
abstract: BACKGROUND
  Intestinal fistulas occur in 4-8% of cases of upper gastrointestinal tract surgery. Until now, surgery has been the standard of treating fistulas in oesophagointestinal anastomosis. The use of stents and haemoclips still causes much controversy, but more and more publications present good results with this type of treatment.
  
  
  OBJECTIVE
  To present results of endoscopic and surgical treatment of fistulas in oesophagointestinal anastomosis after gastrectomy.
  
  
  METHODS
  A fistula in the oesophagointestinal anastomosis was observed in 23 (4.8%) patients within an 18-year period. The indications for endoscopic treatment were small fistulas (< 50 ml/day), and large (> 50 ml/day) fistulas in subjects with no symptoms of peritonitis or abscess were treated with implantation a of covered stent. Surgical treatment was performed with a large fistula leading to peritonitis and complicated gangrene of margins and/or the presence of abscess.
  
  
  RESULTS
  Four subjects were treated endoscopically with the use of haemoclips, resulting in 50% technical and clinical success. We implanted stents in 12 patients. Technical success was achieved in all the patients, yet permanent closure of the fistula was reported for 8 (66%) subjects. The percentage of patients operated on for fistula was 33%. We recorded 4 deaths in this group.
  
  
  CONCLUSIONS
  The use of haemoclips in treatment of small fistulas, and self-expandable, covered stents in treatment of medium and large fistulas, is an effective method that shortens the hospitalisation period and accelerates introduction of oral nutrition while reducing the number of fatal complications.
authors: First Chair and Clinic of General, Vascular and Oncological Surgery, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
authors: Tomasz
authors: T
authors: Miłek
authors: First Chair and Clinic of General, Vascular and Oncological Surgery, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
authors: Piotr
authors: P
authors: Ciostek
authors: Gastrology Department, Food and Nutrition Institute, Warsaw, Poland.
authors: Robert
authors: R
authors: Petryka
authors: Gastrology Department, Food and Nutrition Institute, Warsaw, Poland.
authors: Jakub
authors: J
authors: Słowik
authors: Gastrology Department, Food and Nutrition Institute, Warsaw, Poland.
authors: Mirosław
authors: M
authors: Jarosz
keywords: intestinal fistula; oesophagointestinal anastomosis