Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder

Resumo Introduction: Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascul...

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Bibliographic Details
Published in:GE Portuguese journal of gastroenterology 2023-09, Vol.30 (Suppl 1), p.52-56
Main Authors: Kumaira Fonseca, Mariana, Coelho, Nelson Heitor Vieira, Manica, João Luiz Langer, Ramblo, Rafael Ramos, Spier, Ingrid Elisa, Seabra, Artur Pacheco
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
bariatric surgery
Body mass index
Case reports
Clinical Case Study
Conflicts of interest
Contrast agents
Endoscopy
Fistula
gastric fistula
gastrointestinal
Gastrointestinal surgery
Hernias
Medical imaging
Multidisciplinary teams
Sealing compounds
Sepsis
septal occluder device
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Summary:Resumo Introduction: Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascular defects, including gastrointestinal (GI) disruptions. Previous case reports have reported similar results with the CSDO Amplatzer™ for the management of GI disruptions following bariatric surgery. However, the use of similar alternative devices for this purpose has not yet been described. Case Presentation: This case report presents the first reported use of the Occlutech® CSDO for the treatment of a chronic gastrocutaneous fistula after bariatric revisional surgery. Despite apparent initial success – no extravasation of contrast material through the device in the contrast study after the CSDO placement – fistula closure failed due to partial dislodgement of the device. The placement of a second device between the discs of the former one ultimately sealed the fistulous orifice. Discussion: In chronic GI fistulas, the mature tract is often not liable to the application of standard endoscopic methods, leading to failed closure attempts. A new application of Occlutech® CSDO can obviate the clinical burden of a high-risk laparotomy in these cases. Appropriate endoscopic equipment as well as the involvement of a multidisciplinary team are prime conditions to ensure successful patient outcomes.
ISSN:2341-4545
2387-1954
DOI:10.1159/000526507