Fibrin Glue in the Endoscopic Treatment of Fistulae and Anastomotic Insufficiencies of the Gastrointestinal Tract

Abstract

Background: Fistulae or leakages of anastomotic junctions of the gastrointestinal tract used to be an indication for surgery. However, patients often are severely ill and endoscopic therapeutic options have been suggested recently to avoid surgical intervention. The value of fibrin glue in this situation is not fully validated yet.Aim: Retrospective analysis of the use of fibrin glue in the treatment of gastrointestinal fistulae or anastomotic insufficiencies. Material and Methods: From September 1996 to November 2002, 52 patients (16 female, 36 male; aged 27 to 82 years) with gastrointestinal fistulae or insufficiencies have been treated endoscopically including the use of fibrin glue (Tissucol Duo S®, Baxter, Unterschleissheim, Germany). Clinical data including concomitant therapies and results were analysed by chart review. Results: 26 lesions were located in the esophagus or gastroesophageal junction, 4 in the stomach, 7 in the small intestine, 13 colorectal, and 2 pancreatic. The duration of treatment ranged from 12 to 1765 days (median 70 days), inpatient treatment from 3 to 262 days (median 48.5 days). 2 to 81 ml fibrin glue (median 8.5) were used in 1 to 40 sessions (median 4). All patients received antibiotics, additional endoscopic options were frequently applied (4 histoacryl injections, 17 clippings, 10 stent insertions, 2 endoscopic sutures). Endoscopic therapy cured 55.7% of patients (n = 29), 36.5% (n = 19) were cured with fibrin glue alone. In 23.1% surgical intervention became necessary. Patients without major infectious complications tended to have a higher cure rate without surgery (87.5% vs. 50%). 11 patients died (21.1%), in 9 of them association between gastrointestinal leakage and death seemed likely or possible. Conclusion: Endoscopic therapy is a valuable option in the treatment of fistulae and anastomotic insufficiencies of the gastrointestinal tract. It usually is applied repeatedly. Fibrin glue is a mainstay of this procedure. Major infectious complications seem to define a subgroup of patients with poorer outcome.