Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder
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 defe...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Karger Publishers
2022-09-01
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| Series: | GE: Portuguese Journal of Gastroenterology |
| Subjects: | |
| Online Access: | https://beta.karger.com/Article/FullText/526507 |
| _version_ | 1811229309708271616 |
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| author | Mariana Kumaira Fonseca Nelson Heitor Vieira Coelho João Luiz Langer Manica Rafael Ramos Ramblo Ingrid Elisa Spier Artur Pacheco Seabra |
| author_facet | Mariana Kumaira Fonseca Nelson Heitor Vieira Coelho João Luiz Langer Manica Rafael Ramos Ramblo Ingrid Elisa Spier Artur Pacheco Seabra |
| author_sort | Mariana Kumaira Fonseca |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T10:12:27Z |
| format | Article |
| id | doaj.art-8fe3771794944517b28fb9dcee49575f |
| institution | Directory Open Access Journal |
| issn | 2341-4545 2387-1954 |
| language | English |
| last_indexed | 2024-04-12T10:12:27Z |
| publishDate | 2022-09-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | GE: Portuguese Journal of Gastroenterology |
| spelling | doaj.art-8fe3771794944517b28fb9dcee49575f2022-12-22T03:37:17ZengKarger PublishersGE: Portuguese Journal of Gastroenterology2341-45452387-19542022-09-011510.1159/000526507526507Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal OccluderMariana Kumaira Fonseca0Nelson Heitor Vieira Coelho1João Luiz Langer Manica2Rafael Ramos Ramblo3Ingrid Elisa Spier4Artur Pacheco Seabra5General Surgery Department, Hospital Moinhos de Vento, Porto Alegre, BrazilGastroenterology and Endoscopy Department, Hospital Moinhos de Vento, Porto Alegre, BrazilInterventional Cardiology in Congenital Heart Disease Department, Hospital Moinhos de Vento, Porto Alegre, BrazilRadiology and Diagnostic Imaging Department, Hospital Moinhos de Vento, Porto Alegre, BrazilCritical Care and Internal Medicine Departments, Hospital Moinhos de Vento, Porto Alegre, BrazilGeneral Surgery Department, Hospital Moinhos de Vento, Porto Alegre, BrazilIntroduction: 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.https://beta.karger.com/Article/FullText/526507bariatric surgerygastric fistulaendoscopygastrointestinalseptal occluder device |
| spellingShingle | Mariana Kumaira Fonseca Nelson Heitor Vieira Coelho João Luiz Langer Manica Rafael Ramos Ramblo Ingrid Elisa Spier Artur Pacheco Seabra Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder GE: Portuguese Journal of Gastroenterology bariatric surgery gastric fistula endoscopy gastrointestinal septal occluder device |
| title | Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder |
| title_full | Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder |
| title_fullStr | Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder |
| title_full_unstemmed | Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder |
| title_short | Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder |
| title_sort | endoscopic management of a chronic gastrocutaneous fistula after bariatric revisional surgery using a novel cardiac septal occluder |
| topic | bariatric surgery gastric fistula endoscopy gastrointestinal septal occluder device |
| url | https://beta.karger.com/Article/FullText/526507 |
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