RESUMEN
Fistulas in the upper gastrointestinal (GI) tract are complex conditions associated with elevated morbidity and mortality. They may arise as a result of inflammatory or malignant processes or following medical procedures, including endoscopic and surgical interventions. The management of upper GI is often challenging and requires a multidisciplinary approach. Accurate diagnosis, including endoscopic and radiological evaluations, is crucial to build a proper and personalized therapeutic plan, that should take into account patient's clinical conditions, time of onset, size, and anatomical characteristics of the defect. In recent years, several endoscopic techniques have been introduced for the minimally invasive management of upper GI fistulas, including through-the-scope and over-the-scope clips, stents, endoscopic suturing, endoluminal vacuum therapy (EVT), tissue adhesives, endoscopic internal drainage. This review aims to discuss and detail the current available endoscopic techniques for the treatment of upper GI fistulas.
Asunto(s)
Endoscopía Gastrointestinal , Fístula Gástrica , Humanos , Endoscopía Gastrointestinal/métodos , Fístula Gástrica/terapia , Fístula Gástrica/cirugía , Stents , Resultado del Tratamiento , Fístula Esofágica/terapia , Fístula Esofágica/cirugía , Fístula Esofágica/diagnóstico por imagen , Drenaje/instrumentación , Drenaje/métodos , Tracto Gastrointestinal Superior/diagnóstico por imagenAsunto(s)
Dolor Abdominal/etiología , Fiebre/etiología , Fístula Gástrica/etiología , Pancreatitis Aguda Necrotizante/complicaciones , Enfermedades del Bazo/etiología , Adulto , Diagnóstico Diferencial , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/terapia , Valor Predictivo de las Pruebas , Pronóstico , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/terapia , Tomografía Computarizada por Rayos XAsunto(s)
Coagulación con Plasma de Argón , Fístula Cutánea/terapia , Nutrición Enteral/efectos adversos , Fístula Gástrica/terapia , Complicaciones Posoperatorias/terapia , Preescolar , Fístula Cutánea/etiología , Drenaje/instrumentación , Fístula Gástrica/etiología , Humanos , Yeyunostomía/efectos adversos , Yeyunostomía/instrumentación , Ilustración Médica , Complicaciones Posoperatorias/etiologíaAsunto(s)
Fístula del Sistema Digestivo/terapia , Embolización Terapéutica , Fístula Gástrica/terapia , Hepatopatías/terapia , Anciano , Angiografía , Carcinoma Hepatocelular/terapia , Fístula del Sistema Digestivo/diagnóstico por imagen , Fístula Gástrica/diagnóstico por imagen , Humanos , Hepatopatías/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Imagen por Resonancia Magnética , Masculino , Radioisótopos de ItrioRESUMEN
INTRODUCTION AND AIMS: PEG removal in head and neck cancer patients (HNCPs) is performed after treatment, in case of disease remission and after adequate oral intake is resumed. The PEG tract usually closes spontaneously within 2-3 days. Persistent gastrocutaneous fistula (GCF) is a rare complication after PEG tube removal and is characterized by the persistence of gastric leakage through the fistulous tract for more than 1 month. Our main goal was to access the incidence and the success of a treatment algorithm for GCF in HNCPs. METHODS: Retrospective unicentric study of HNCPs referred for PEG removal between 2014 and 2018. The patients with GCF were selected and their sequential treatment was reviewed. RESULTS: In 331 patients with PEGs removed, 19 (5.7%) GCFs were documented. Medical therapy (4-8 weeks) was performed with clinical success (definitive closure of the GCF) in 12 (63.2%) patients. The remaining seven patients required endoscopic or surgical treatment. In four, endoscopic treatment had technical and clinical success (in three patients with fulguration of the gastric leak edges with argon plasma coagulation, silver nitrate in the path and external orifice, and closure of the internal orifice with hemoclips and in one with an over-the-scope-clip). Only three patients underwent surgery, one due to clinical failure of sequential endoscopic therapy and two had direct surgery. CONCLUSION: GCF occurs rarely after PEG removal in HNCPs. Medical therapy is usually effective and should be maintained for at least 8 weeks. Endoscopic therapy is an effective second-line option with and surgery rarely required.
Asunto(s)
Fístula Cutánea/etiología , Fístula Gástrica/etiología , Gastrostomía/efectos adversos , Neoplasias de Cabeza y Cuello/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fístula Cutánea/terapia , Remoción de Dispositivos/efectos adversos , Electrocoagulación/efectos adversos , Electrocoagulación/métodos , Endoscopía/efectos adversos , Endoscopía/métodos , Femenino , Fístula Gástrica/terapia , Gastrostomía/instrumentación , Gastrostomía/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Instrumentos Quirúrgicos , Resultado del Tratamiento , Adulto JovenRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Gastrectomía/efectos adversos , Fístula Gástrica/etiología , Fístula Gástrica/terapia , Estudios Retrospectivos , Complicaciones Posoperatorias/terapia , Resultado del Tratamiento , Factores de TiempoRESUMEN
BACKGROUND: The management for subacute or chronic fistula after bariatric surgery is very complicated and with no standard protocol yet. It is also an Achilles' heel of all bariatric surgery. The aim of this case report is to describe our experience in managing this complication by percutaneous embolization, a less commonly used method. CASE PRESENTATION: A 23-year-old woman with a body mass index of 35.7 kg/m2 presented with delayed gastric leak 7 days after laparoscopic sleeve gastrectomy (LSG) for weight reduction. Persistent leak was still noted under the status of nil per os, nasogastric decompression, and parenteral nutrition for 1 month; therefore, endoscopic glue injection was performed. The fistula tract did not seal off, and the size of pseudocavity enlarged after gas inflation during endoscopic intervention. Subsequently, we successfully managed this subacute gastric fistula via percutaneous fistula tract embolization (PFTE) with removal of the external drain 2 months after LSG. CONCLUSIONS: PFTE can serve as one of the non-invasive methods to treat subacute gastric fistula after LSG. The usage of fluoroscopy-visible glue for embolization can seal the fistula tract precisely and avoid the negative impact from gas inflation during endoscopic intervention.
Asunto(s)
Embolización Terapéutica , Gastrectomía , Fístula Gástrica , Laparoscopía , Obesidad Mórbida , Femenino , Gastrectomía/efectos adversos , Fístula Gástrica/etiología , Fístula Gástrica/terapia , Humanos , Obesidad , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
A gastrogastric fistula is a rare complication of Roux-en-Y gastric bypass resulting from communication between the gastric pouch and gastric remnant. This case report describes the creative interprofessional management of this condition arising in a 48-year-old woman. During an elective Roux-en-Y gastric bypass surgery for morbid obesity, the patient developed respiratory complications. She was admitted to the ICU, but the following day she signed herself out against medical advice, stating she was "no longer staying here." Within 24 hours, she returned to the ED for postoperative complications, and a week after the exploratory surgery, the patient developed an inoperable high-output fistula. The authors devised a creative solution to contain the effluent and achieved closure of the fistula after several weeks.
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Derivación Gástrica/efectos adversos , Fístula Gástrica/etiología , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/etiología , Femenino , Derivación Gástrica/métodos , Fístula Gástrica/terapia , Humanos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Complicaciones Posoperatorias/cirugía , Reoperación , Resultado del TratamientoRESUMEN
BACKGROUND: Thoracogastric airway fistula (TGAF) is a serious complication of esophagectomy for esophageal cancer. We conducted a systematic review of the appropriate therapeutic options for acquired TGAF. METHODS: We performed a literature search to identify relevant studies from PubMed, EMBASE, and Web of Science using the search terms "gastric airway fistula", "gastrotracheal fistula", "gastrobronchial fistula", "tracheogastric fistula", "bronchogastric fistula", "esophageal cancer", and "esophagectomy". RESULT: Twenty-four studies (89 patients) were selected for analysis. Cough was the main clinical presentation of TGAF. The main bronchus was the most common place for fistulas (53/89), and 29 fistulas occurred in the trachea. Almost 73% (65/89) of patients underwent non-surgical treatment of whom 87.7% (57/65) received initial fistula closure. Twenty-three patients underwent surgery, including 19 (82.6%) with initial closure. The 1-, 2-, 3-, 6-, and 9-month survival rates in patients who underwent surgical repair were 95.65%, 95.65%, 82.61%, 72.73%, and 38.10%, respectively, and the equivalent survival rates in patients with tracheal stent placement were 91.67%, 86.67%, 71.67%, 36.96%, and 13.33%, respectively. CONCLUSION: TGAF should be suspected in patients with persistent cough, especially in a recumbent position or associated with food intake. Individualized treatment should be emphasized based on the general condition of each patient.
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Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Fístula Gástrica/terapia , Complicaciones Posoperatorias/terapia , Fístula del Sistema Respiratorio/terapia , Bronquios/cirugía , Tratamiento Conservador/métodos , Fístula Gástrica/diagnóstico , Fístula Gástrica/etiología , Fístula Gástrica/mortalidad , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Fístula del Sistema Respiratorio/diagnóstico , Fístula del Sistema Respiratorio/etiología , Fístula del Sistema Respiratorio/mortalidad , Stents , Estómago/cirugía , Tasa de Supervivencia , Tráquea/cirugía , Resultado del TratamientoAsunto(s)
Abdomen Agudo , Endoscopía/métodos , Fístula Gástrica/cirugía , Pancreatitis , Abdomen/diagnóstico por imagen , Abdomen/cirugía , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Abdomen Agudo/terapia , Enfermedad Aguda , Adulto , Fuga Anastomótica/terapia , Antibacterianos/administración & dosificación , Ascitis/complicaciones , Bacitracina/administración & dosificación , Contraindicaciones , Desbridamiento , Derivación Gástrica/efectos adversos , Fístula Gástrica/diagnóstico , Fístula Gástrica/terapia , Tracto Gastrointestinal/irrigación sanguínea , Tracto Gastrointestinal/patología , Humanos , Infusiones Parenterales , Isquemia/etiología , Cirrosis Hepática/complicaciones , Masculino , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiología , Fístula Pancreática/terapia , Jugo Pancreático , Pancreatitis/complicaciones , Pancreatitis/diagnóstico por imagen , Pancreatitis/cirugía , Pancreatitis/terapia , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/cirugía , Pancreatitis Aguda Necrotizante/terapia , Úlcera Péptica Perforada/diagnóstico , Úlcera Péptica Perforada/etiología , Úlcera Péptica Perforada/terapia , Cavidad Peritoneal/diagnóstico por imagen , Cavidad Peritoneal/cirugía , Implantación de Prótesis , Recurrencia , Stents Metálicos Autoexpandibles , Circulación Esplácnica , Irrigación Terapéutica , Trombosis/etiologíaAsunto(s)
Fístula Cutánea/terapia , Fístula Gástrica/terapia , Gastrostomía/efectos adversos , Complicaciones Posoperatorias/terapia , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Vendajes , Tratamiento Conservador/métodos , Fístula Cutánea/etiología , Fístula Gástrica/etiología , Gastrostomía/métodos , Humanos , Masculino , Combinación Piperacilina y Tazobactam/uso terapéutico , Complicaciones Posoperatorias/etiología , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
BACKGROUND: Thoracogastric-airway fistula (TGAF) post-thoracic surgery is a rare and challenging complication for esophagectomy. The aim of this study was to explore the effectiveness of airway stenting for TGAF patients and find related factors coupled with healing of fistula. METHODS: This is a retrospective study involving patients with TGAF who were treated with airway stentings. Based on different TGAF locations and sizes on chest computed tomography, covered metallic or silicon airway stents were implanted to cover orifices under interventional bronchoscopy. TGAF healing was defined as the primary outcome, and complete sealing of TGAF as the second outcome. The predictors for TGAF healing were analyzed in univariate and multivariate analysis. RESULTS: A total of 58 TGAF patients were included, of whom 7 received straight covered metallic stents, 5 straight silicon stents, 3 L-shaped covered metallic stents, 21 large Y-shaped covered metallic stents, 17 large Y-shaped silicon stents, and 5 with Y-shaped covered metallic stents. Healing was achieved in 20 (34.5%) patients, and complete sealing in 45 (77.6%) patients. There were no significant differences in healing rate and complete sealing rate between patients receiving metallic stents and those with silicon stents. In univariate analysis, lacking a previous history of radiotherapy or chemotherapy, nonmalignant fistulas, small fistulas, and shorter postesophagectomy duration were found associated with a higher rate of TGAF healing. Only shorter postesophagectomy duration was associated with TGAF healing in multivariate analysis. CONCLUSIONS: Both silicon and covered metallic airway stenting are effective methods to close TGAF. A shorter postesophagectomy period may predict better TGAF healing. The reviews of this paper are available via the supplemental material section.
Asunto(s)
Broncoscopía/instrumentación , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Fístula Gástrica/terapia , Fístula del Sistema Respiratorio/terapia , Stents , Adulto , Anciano , Broncoscopía/efectos adversos , Neoplasias Esofágicas/patología , Femenino , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Humanos , Masculino , Metales , Persona de Mediana Edad , Diseño de Prótesis , Fístula del Sistema Respiratorio/diagnóstico por imagen , Fístula del Sistema Respiratorio/etiología , Estudios Retrospectivos , Siliconas , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
This case reports a iatrogenic gastric fistula due to external draining successfully closed by using an over- the-scope clip. A 50-year old patient with a history of acute pancreatitis, segmental portal hypertension and splenectomy for splenic rupture, with long-term external drainage for a low volume pancreatic fistula, was referred to our hospital. The patient noticed the occurrence of a sudden increase of the drain flow and the immediate drainage of ingested liquid, with no fever or pain. An upper gastrointestinal endoscopy evidenced the gastric fistula with the presence of the drain inside the stomach near a gastric varix. The surgical approach was inappropriate due to bleeding risk. An over-the-scop clip was placed succeeding to stop the gastric flow. The external fistula closed one week later.
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Fístula Cutánea/terapia , Drenaje/efectos adversos , Fístula Gástrica/terapia , Estómago/lesiones , Fístula Cutánea/etiología , Drenaje/instrumentación , Endoscopía Gastrointestinal/métodos , Fístula Gástrica/etiología , Humanos , Masculino , Persona de Mediana Edad , Fístula Pancreática/terapia , Pancreatitis/diagnóstico por imagen , Pancreatitis/terapia , Tomografía Computarizada por Rayos XRESUMEN
A gastrointestinal-airway fistula (GAF) after esophagectomy is a very serious postoperative complication that can cause severe respiratory complications due to digestive juice inflow. Generally, GAF is managed by invasive surgical treatment; less-invasive treatment has yet to be established. We performed esophageal stent placement (ESP) in three cases of GAF after esophagectomy. We assessed the usefulness of ESP through our clinical experience. All GAFs were successfully managed by ESP procedures. After the procedure, the stent positioning and expansion were appropriately evaluated by radiological assessments over time. The stent was removed after endoscopic confirmation of fistula closure on days 8, 23, and 71. Only one patient with a long-term indwelling stent developed a manageable secondary gastrobronchial fistula as a procedure-related complication. In conclusion, ESP was shown to be a less-invasive and effective therapeutic modality for the treatment of GAF.
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Esofagectomía/efectos adversos , Fístula Gástrica/terapia , Enfermedades Pulmonares/terapia , Fístula del Sistema Respiratorio/terapia , Stents Metálicos Autoexpandibles , Enfermedades de la Tráquea/terapia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Stents Metálicos Autoexpandibles/efectos adversosRESUMEN
Background: There is no time limit for the occurrence of leaks after sleeve gastrectomy LSG, and very late ones might evolve versus persistent, chronic fistulas. The aim of this retrospective study was to analyze the incidence, treatment and outcomes of persistent, chronic fistulas occurred or treated in a bariatric Center of Excellence IFSO-EC (CoE) and to establish a standardized approach. Materials Methods: between 2011-2018, nine cases of postoperative leaks occurred on a total of 1365 LSG performed (0.65%), 7 of them having late presentations (onset over 10 days postoperative). Chronic, persistent fistulas were identified and analyzed, including one gastro-bronchial and one gastro-cutaneous fistulas. Results: We present three peculiar cases of very late, chronic type III fistulas, with onset at 6-84 months after primary LSG and their management, including conservative, interventional radiology and endoscopy and surgical therapies. Conclusions: the management of late, chronic type III fistula is variable, with no standard algorithm to follow, but it should be planned based on the clinical evaluation, time of diagnosis, available resources, multidisciplinary approach and expertise. This emphasises again the necessity of a bariatric CoE that can guarantee a better diagnose and treatment, based on the use of wide, available resources, both professional and material.
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Gastrectomía/efectos adversos , Fístula Gástrica/etiología , Obesidad/cirugía , Fuga Anastomótica/diagnóstico , Fuga Anastomótica/etiología , Fuga Anastomótica/terapia , Enfermedad Crónica , Fístula Gástrica/diagnóstico , Fístula Gástrica/terapia , Humanos , Laparoscopía , Obesidad/complicaciones , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Background: Leaks are rare complications of laparoscopic sleeve gastrectomy (LSG) but, they may cause significant and prolonged morbidity. Enteral nutrition is mandatory for the gastric leak or fistula therapy's success and the naso-jejunal tube (NJT) as well the loop feeding jejunostomy (LFJ) have some limitations and morbidities. We propose an alternative, the laparoscopic Roux-en-Y feeding jejunostomy (LRYFJ) to support the mid- and long-term nutritional need of the patients complicated with gastric leaks or fistulas. Aim: to investigate the laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) and to evaluate the surgical technique, its efficiency and outcomes. Methods: The surgical steps of LRFJ are described in detail and the technical challenges are commented. The IRB approval was obtained for performing the LRYFJ in patients with gastric leaks or fistulas after LSG and to run the present study. All the patients who received LRYFJ in our center since 2015 were included into a prospective study. The patient's medical characteristics, as well the procedure's technical challenges and outcomes are analyzed. Result: Six patients (4 females, 2 males; age 37.1 +- 11.5 years) who previously underwent LSG, were referred to our unit after the initial drainage for gastric leak in other institution and, LRYFJ was performed in all. Mean operative time was 127.5 +- 61.2 minutes. Mean duration of jejunal nutrition was 183.83 +- 128.2 days. No related mortality was encountered. Laparoscopic fistulo-jejunostomy was the definitive fistula treatment in five of the patients (83.3 %) while in one patient (16.6 %) the leak was spontaneously healed. Conclusion: Adequate nutritional support is mandatory for the gastric sleeve leak treatment. LRYFJ has many advantages over naso-jejunal tube and loop type feeding jejunostomy particularly in treatments of prolonged sleeve leaks or fistulas. Our experience demonstrates that LRYFJ can be implemented safely with the technique we described.
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Fuga Anastomótica/terapia , Nutrición Enteral/métodos , Gastrectomía/efectos adversos , Fístula Gástrica/terapia , Yeyunostomía/métodos , Obesidad/cirugía , Anastomosis en-Y de Roux , Fuga Anastomótica/etiología , Femenino , Fístula Gástrica/etiología , Humanos , Laparoscopía , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We describe a patient who developed an intractable leak from the gastric sleeve after laparoscopic sleeve gastrectomy, resulting in the development of a gastrobronchial fistula. Affected individuals typically have a persistent leak from the gastric sleeve with recurrent subphrenic abscesses, and when a gastrobronchial fistula develops, these patients may present with paroxysms of coughing immediately after ingestion of solids or liquids. In the appropriate clinical setting, a barium study not only may show the leak, but also directly visualize the gastrobronchial fistula. If aggressive endoscopic dilation procedures and/or endoscopic placement of stents or clips fail to facilitate healing of the leak and fistula, these patients may require surgical intervention, with conversion of the sleeve to a Roux-en-Y gastric bypass or even a partial or total gastrectomy. The development of a gastrobronchial fistula after sleeve gastrectomy therefore can be extremely challenging to manage.