S1012 Outcomes of Endoscopic Therapy With Over-The-Scope Clip Placement for Fistula Closure in Patients With Inflammatory Bowel Disease

Abstract

Introduction: Fistula management in patients with inflammatory bowel disease (IBD) is complex and requires a multidisciplinary team. Data regarding outcomes of endoscopic intervention with over-the-scope clip (OTSC) placement as a primary endoscopic therapy for fistula closure among IBD patients are limited. Aim: To assess the efficacy and safety of endoscopic therapy with emphasis on OTSC placement for fistula closure in patients with IBD. Methods: A retrospective review of the electronic medical records of patients with IBD who underwent fistula closure with OTSC from December 2011-January 2021 was performed. Data was abstracted for patient demographics, clinical characteristics, endoscopic techniques, and outcomes including need for surgery and fistula closure. Results: A total of 19 patients (13 females; mean age 40.3 (range 17-83) years; mean BMI 23.8 ±7.0 kg/m 2 ) were identified. Of these, 9 (47%) patients had a diagnosis of chronic ulcerative colitis, 9 (47%) Crohn’s disease and 1 (5%) indeterminate colitis. All patients had a history of IBD-related surgery and 10 (53%) patients developed fistulas within 6 months of surgery. Seventeen (89%) patients underwent OTSC placement at their index therapeutic endoscopy (ITE) for fistula closure. Adjunctive treatment modalities to OTSC, including argon plasma coagulation, fibrin glue and endoscopic suturing, were used in over 50% of patients at the ITE and the median number of endoscopic treatment sessions was 2 (range 1-9) (Table 1). Thirteen (68%) patients failed endoscopic therapy and 12 (63%) patients ultimately required surgical interventions, including fistula takedown and bowel resection in 3, bowel resection in 2, and diverting loop ileostomy in 4 and/or pouch excision in 5 patients. The mean time from ITE to surgery was 8.9 (range 0.3-35) months. Six (32%) patients were considered to have a successful endoscopic outcome, in whom 4 (21%) patients achieved complete resolution of symptoms and sustained fistula closure on imaging with a mean follow-up of 16.8 (range 0.5-41.5) months from the last endoscopic intervention. Two (10%) patients reported significant symptomatic improvement despite the absence of complete closure on follow-up imaging. No adverse events were reported as a direct result of OTSC placement. Conclusion: OTSC placement with or without adjunctive modalities is successful at closing fistulas in one-third of patients with IBD. Further studies are needed to identify patients who are more likely to benefit from endoscopic therapy.Table 1.: Endoscopic therapies for fistula closure in patients with IBD. Abbreviations: EC = enterocutaneous, IC = Ileocolonic anastomosis, OTSC = over-the-scope-clip, APC = argon plasma coagulation, FG = fibrin glue, ES = endoscopic suturing, SEMS = self-expandable metallic stent, AE = adverse events. *Stent migration requiring endoscopic removal. †Patients 17 and 19 were also treated with plug placement by interventional radiology, patient 17 at the time of the second endoscopy and patient 19 one month after his first endoscopic procedure.