Extracellular matrix enterocutaneous fistula plug placement: An interventional radiology-guided procedure for fistulae refractor y to care

Abstract

Objective: Enteric fistulas are serious bowel injuries that significantly decrease patient life quality. Operative treatments neglect patients who are not surgical candidates or who have failed surgery. One non-operative method is the percutaneous placement of an extracellular matrix enterocutaneous fistula plug (ECMFP), which sits in the fistula tract and constructs a surface into which the fistula heals. Materials and Methods: This study included ten patients who had an ECMFP placed between June 2017 and July 2022 with follow-up through October 2022. The median patient age was 66.5 years. Fistulae origins were gastrocutaneous (n = 1), enterocutaneous (n = 4), and colocutaneous (n = 5). Results: Of the ten patients, fistula closure was achieved in 5 (50%). Closure occurred in three of four enterocutaneous (75%), one of one gastrocutaneous (100%), and one of five colocutaneous fistulae (20%). The median time to closure was 1 month. Successfully closed fistulae had a mean duration of existence of 4.6 months. Failed closures had a mean duration of existence of 15.3 months. Fistulae originating from a percutaneous enteric tube had success in 2 of 3 patients (66%). Fistulae due to diverticulitis did not achieve closure (0 of 3). Conclusions: ECMFPs are a viable treatment to consider in a patient population that has few other options. They can be useful for the closure of fistulae involving the stomach or small bowel with an existence of <1 year. Patients with fistulae of colonic origin, patients who have had fistulae for longer than 1 year, or patients whose fistulae are due to diverticulitis are less likely to see successful closure.