Combination of Argon Plasma Coagulation and Hemoclip for Therapeutic Closure of Persistent Gastrocuntaneous Fistula

Abstract

Purpose: Persistent gastrocutaneous fistula (PGCF) is a well-known complication of percutaneous endoscopic gastrostomy (PEG) tube. Drainage from a non-healing PGCF can lead to abdominal wall cellulitis. Various conservative, surgical, and endoscopic treatment approaches have been described in the literature. In this case report, we present a unique combination of argon plasma coagulation (APC) and endoscopic hemoclips (EHC) for treatment of PGCF. To our knowledge, only one such case has been reported. Case Report: A 60 y/o male with T4 N2c M1 oral squamous cell carcinoma, had uneventful 20 Fr PEG tube for 16 months. He presented with leakage from the PEG tube site which did not improve with changing to larger size tube. Ultimately the tube was removed due to worsening cellulitis. Drainage of gastric contents from this gastrocutaneous fistula was associated with local skin erythema and edema. Conservative methods including proton pump inhibitors, prokinetics, topical silver nitrate, parenteral nutrition and antibiotics were unsuccessful. Endoscopy revealed a 2 cm inner opening of the fistula tract. APC was applied on the inner aspect of the fistula tract followed by approximation of the edges of the internal tract by using EHC. Clear liquids were started on the following day. After a week, no further drainage was noted at the fistula site and he was able to tolerate regular diet. Conclusion: Our experience suggests that use of APC to de-endothelialize and EHC to appose the inner edges could be considered to treat PGCF. In addition to promoting recovery, early adoption of this cost-effective method may prevent cellulitis of abdominal wall and use of parenteral nutrition.Figure: [1374]