Treatment of foregut fistula with biologic plugs

R. Filgate, A. Thomas, Mohammed Ballal

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    © 2014, Springer Science+Business Media New York. Introduction: Enteric fistulas are a recognised complication of various diseases and surgical interventions. Non-operative medical management will result in closure of 60–70 % of all fistulas over a six- to eight-week period, those that fail non-operative management will require operative intervention if they are to close. We present a series of upper gastrointestinal fistula managed with endoscopic intervention and insertion of biological fistula plug over a 3-year period across three Hospitals, both public and private, in Western Australia. Methods: Over a three-year period, 14 patients were referred for treatment of acute or persistent foregut fistulas. All fistulas were managed with endoscopic intervention and insertion of a porcine small intestine sub-mucosa plug (Biodesign ® Cook medical Inc., Bloomington, IN, USA). No patients with fistula were excluded. Data were collected on patient demographics and underlying diagnosis. The biological plugs were deployed using three different endoscopic techniques (direct deployment via the endoscope, catheter-assisted endoscopic deployment, or a pull through via a guide wire using a rendezvous technique). Results: Fourteen patients with foregut fistula were treated using biological plugs. The age of the fistulas treated ranged from 14 days to 3 years. The fistulas were predominantly gastric in origin (eight cases). Three oesophageal, one gastro-pleural-bronchial, and two jejunal fistulas were also managed using this technique. Of the 14 fistulas treated using this method, 13 resolved following the treatment. Median time to closure of the fistula was 2 days (range 1–120 days). Three patients required more than one intervention to complete closure. Conclusion: Biological plugs offer a further option for management of the traditionally difficult foregut fistula, without major morbidity associated with other treatment modalities. It is limited to the ability to deploy the plug endoscopically.
    Original languageEnglish
    Pages (from-to)2006-2012
    JournalSurgical Endoscopy
    Volume29
    Issue number7
    DOIs
    Publication statusPublished - 2015

    Fingerprint

    Fistula
    Therapeutics
    Western Australia
    Private Hospitals
    Endoscopes
    Public Hospitals
    Small Intestine
    Stomach
    Mucous Membrane
    Swine
    Catheters
    Demography
    Morbidity

    Cite this

    Filgate, R. ; Thomas, A. ; Ballal, Mohammed. / Treatment of foregut fistula with biologic plugs. In: Surgical Endoscopy. 2015 ; Vol. 29, No. 7. pp. 2006-2012.
    @article{3fe7111a2cb6468dafbd5895a92f3fc0,
    title = "Treatment of foregut fistula with biologic plugs",
    abstract = "{\circledC} 2014, Springer Science+Business Media New York. Introduction: Enteric fistulas are a recognised complication of various diseases and surgical interventions. Non-operative medical management will result in closure of 60–70 {\%} of all fistulas over a six- to eight-week period, those that fail non-operative management will require operative intervention if they are to close. We present a series of upper gastrointestinal fistula managed with endoscopic intervention and insertion of biological fistula plug over a 3-year period across three Hospitals, both public and private, in Western Australia. Methods: Over a three-year period, 14 patients were referred for treatment of acute or persistent foregut fistulas. All fistulas were managed with endoscopic intervention and insertion of a porcine small intestine sub-mucosa plug (Biodesign {\circledR} Cook medical Inc., Bloomington, IN, USA). No patients with fistula were excluded. Data were collected on patient demographics and underlying diagnosis. The biological plugs were deployed using three different endoscopic techniques (direct deployment via the endoscope, catheter-assisted endoscopic deployment, or a pull through via a guide wire using a rendezvous technique). Results: Fourteen patients with foregut fistula were treated using biological plugs. The age of the fistulas treated ranged from 14 days to 3 years. The fistulas were predominantly gastric in origin (eight cases). Three oesophageal, one gastro-pleural-bronchial, and two jejunal fistulas were also managed using this technique. Of the 14 fistulas treated using this method, 13 resolved following the treatment. Median time to closure of the fistula was 2 days (range 1–120 days). Three patients required more than one intervention to complete closure. Conclusion: Biological plugs offer a further option for management of the traditionally difficult foregut fistula, without major morbidity associated with other treatment modalities. It is limited to the ability to deploy the plug endoscopically.",
    author = "R. Filgate and A. Thomas and Mohammed Ballal",
    year = "2015",
    doi = "10.1007/s00464-014-3903-1",
    language = "English",
    volume = "29",
    pages = "2006--2012",
    journal = "Surgical Endoscopy",
    issn = "0930-2794",
    publisher = "Springer",
    number = "7",

    }

    Treatment of foregut fistula with biologic plugs. / Filgate, R.; Thomas, A.; Ballal, Mohammed.

    In: Surgical Endoscopy, Vol. 29, No. 7, 2015, p. 2006-2012.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Treatment of foregut fistula with biologic plugs

    AU - Filgate, R.

    AU - Thomas, A.

    AU - Ballal, Mohammed

    PY - 2015

    Y1 - 2015

    N2 - © 2014, Springer Science+Business Media New York. Introduction: Enteric fistulas are a recognised complication of various diseases and surgical interventions. Non-operative medical management will result in closure of 60–70 % of all fistulas over a six- to eight-week period, those that fail non-operative management will require operative intervention if they are to close. We present a series of upper gastrointestinal fistula managed with endoscopic intervention and insertion of biological fistula plug over a 3-year period across three Hospitals, both public and private, in Western Australia. Methods: Over a three-year period, 14 patients were referred for treatment of acute or persistent foregut fistulas. All fistulas were managed with endoscopic intervention and insertion of a porcine small intestine sub-mucosa plug (Biodesign ® Cook medical Inc., Bloomington, IN, USA). No patients with fistula were excluded. Data were collected on patient demographics and underlying diagnosis. The biological plugs were deployed using three different endoscopic techniques (direct deployment via the endoscope, catheter-assisted endoscopic deployment, or a pull through via a guide wire using a rendezvous technique). Results: Fourteen patients with foregut fistula were treated using biological plugs. The age of the fistulas treated ranged from 14 days to 3 years. The fistulas were predominantly gastric in origin (eight cases). Three oesophageal, one gastro-pleural-bronchial, and two jejunal fistulas were also managed using this technique. Of the 14 fistulas treated using this method, 13 resolved following the treatment. Median time to closure of the fistula was 2 days (range 1–120 days). Three patients required more than one intervention to complete closure. Conclusion: Biological plugs offer a further option for management of the traditionally difficult foregut fistula, without major morbidity associated with other treatment modalities. It is limited to the ability to deploy the plug endoscopically.

    AB - © 2014, Springer Science+Business Media New York. Introduction: Enteric fistulas are a recognised complication of various diseases and surgical interventions. Non-operative medical management will result in closure of 60–70 % of all fistulas over a six- to eight-week period, those that fail non-operative management will require operative intervention if they are to close. We present a series of upper gastrointestinal fistula managed with endoscopic intervention and insertion of biological fistula plug over a 3-year period across three Hospitals, both public and private, in Western Australia. Methods: Over a three-year period, 14 patients were referred for treatment of acute or persistent foregut fistulas. All fistulas were managed with endoscopic intervention and insertion of a porcine small intestine sub-mucosa plug (Biodesign ® Cook medical Inc., Bloomington, IN, USA). No patients with fistula were excluded. Data were collected on patient demographics and underlying diagnosis. The biological plugs were deployed using three different endoscopic techniques (direct deployment via the endoscope, catheter-assisted endoscopic deployment, or a pull through via a guide wire using a rendezvous technique). Results: Fourteen patients with foregut fistula were treated using biological plugs. The age of the fistulas treated ranged from 14 days to 3 years. The fistulas were predominantly gastric in origin (eight cases). Three oesophageal, one gastro-pleural-bronchial, and two jejunal fistulas were also managed using this technique. Of the 14 fistulas treated using this method, 13 resolved following the treatment. Median time to closure of the fistula was 2 days (range 1–120 days). Three patients required more than one intervention to complete closure. Conclusion: Biological plugs offer a further option for management of the traditionally difficult foregut fistula, without major morbidity associated with other treatment modalities. It is limited to the ability to deploy the plug endoscopically.

    U2 - 10.1007/s00464-014-3903-1

    DO - 10.1007/s00464-014-3903-1

    M3 - Article

    VL - 29

    SP - 2006

    EP - 2012

    JO - Surgical Endoscopy

    JF - Surgical Endoscopy

    SN - 0930-2794

    IS - 7

    ER -