ENDOSCOPIC CLOSURE OF GASTROCUTANEOUS FISTULA IN CHILDREN FOLLOWING GASTROSTOMY TUBE REMOVAL

Abstract

Purpose: Purpose of the study is to report our experience with endoscopic closure of gastrocutaneous (GC) fistula after removal of gastrostomy tube (GT) in four pediatric patients. Earlier, patients with GC fistula were managed by surgical resection and closure of gastrostomy. Methods: Retrospective chart review was performed in four consecutive patients who had undergone endoscopic closure of GC fistula over last six months. GT was removed when patients maintained growth for more than three months without use of the GT. H2 blocker was given if GT site drained for more than a week. If GT site drained more than two weeks after removal of GT, then upper endoscopy (UE) was performed and gastric opening of the fistula was closed with Endoclip®. UE and Endoclip® were repeated in two weeks if drainage persisted or recurred. Supplemental treatment included cauterzation of external granuloma with silver nitrate, application of Flo-Seal® in or around the gastrostomy, and small volume feedings for two weeks. Results: Conclusions: 1. Persistent GC fistula, after removal of GT, may occur in patients in whom GT had been in place for more than 10 months. 2. Endoscopic application of clip (supplemented with external topical silver nitrate and Flo-SealR) is successful in achieving closure of GC fistula, thus avoiding surgery. 3. More than one session of UE with clip application may be required for successful closure of GC fistula.Table: Clinical features and response to Endoclip®