932 Efficacy and Outcomes of Endoscopic Gastrointestinal Fistula Closure: A Single Center Study

Abstract

INTRODUCTION: Historically, patients with gastrointestinal fistulas who have failed conservative management required surgical intervention. The advent of novel endoscopic devices has revolutionized endoscopic closure of gastrointestinal fistulas presenting a promising and less invasive alternative to surgery. Our study aims to evaluate the efficacy and outcomes of endoscopic closure of gastrointestinal fistulas from a single center database. METHODS: We performed a retrospective review of all patients from 2009 to 2019 undergoing endoscopic closure of gastrointestinal fistulas at our tertiary referral center. Demographics, nutritional status, type of fistula, modality of endoscopic repair, number of attempts at closure, technical and clinical success rates, and adverse events were collected. RESULTS: A total of 130 procedures were reviewed from 75 patients undergoing endoscopic fistula repair over a 10 year period, 40 males / 35 females, with a median age of 56.5 years. Mean BMI was 26.4 (kg/m2) with a mean albumin of 3.4 (normal > 4). Upper GI closures accounted for 85.3% of cases (64/75) vs lower GI was 14.7% (11/75). The median number of attempts for endoscopic closure was 1 (range 1-5). Technical success rate was 97.7% (127/130). Single modality closure techniques were used in 63% (82/130) of procedures. The most frequently used modality of closure was endoscopic stenting (51/130, 39.2%), followed by endosuture (39/130, 30%), over-the-scope-clips (28/130, 21.5%), endoclip (24/130, 18.5%), APC (20/130, 15.4%), fibrin glue (7/130, 5.4%), and others (3/130, 2.3%). Multimodality closure using a combination above devices was used in 37% (48/130). Clinical success rate for documented complete endoscopic fistula closure was seen in 45.3% (34/75) of cases, while 28% (21/75) needed surgical intervention, and the remaining were managed conservatively. The adverse event rate was 3% (4 cases of stent migration). CONCLUSION: Endoscopic intervention of gastrointestinal fistula closure has a high technical success rate and can avoid almost half the cases going to surgical repair. New endoscopic techniques, along with the use of multimodality closure, can be used to increase overall clinical success rate, especially in post-surgical anatomy. Endoscopic therapies of gastrointestinal fistulas are efficacious and offer a safe alternative to surgery for high risk patients.