Getting Closure: Gastrocutaneous Fistula Repair In The Era Of Endoscopic Suturing

INTRODUCTION: Formation of a gastrocutaneous fistula (GCF) is an uncommon complication following gastrostomy tube removal. GCFs rarely close spontaneously leading to nutrition support challenges and poor patient quality of life. Methods for endoscopic closure include glue injection, banding, and use of endoclips, however limited data exists about the efficacy of endoscopic suturing for GCF management. We aimed to evaluate the success of endoscopic suturing in closure of gastro-cutaneous fistulae after gastrostomy tube removal. CASE DESCRIPTION/METHODS: We performed a retrospective study using our electronic endoscopy database between 2018 and 2019. All patients during the study period who underwent endoscopic suture for closure of GCF after gastrostomy tube removal were identified. Data was collected regarding patient characteristics, co-morbid conditions as well as technical success, clinical success and procedure complication rate. Endoscopic suturing of GCF using the Apollo Overstitch system was performed six times in four patients. The average age was 69 years and 75% of patients were female. All patients had previous attempt for closure of GCF with either suturing of the skin (n = 3), bedside debridement (n = 1) or over-the-scope clip (n = 1). Debridement of the fistulous tract was performed in all patients undergoing endoscopic suturing using argon plasma coagulation and/or cytology brush. Endoscopic suturing was technically successfully in 100% of the cases and immediate post-procedure clinical success was achieved in 100% of cases. Long-term clinical success rate was achieved in 3 out of 4 patients (75%) with median follow up of 124 days. No procedure-related complications were observed. The only patient without durable clinical success had an over the scope clip in place which wasn’t able to be removed prior to suturing. DISCUSSION: Our initial experience suggests that endoscopic suturing is a safe and effective modality for closure of gastrocutaneous fistulae following gastrostomy tube removal and may be considered as first line therapy in these challenging clinical cases.Table 1.: Patient demographic data, surgical history, and periprocedural information.Table 2.: Procedural information and outcomes