SIR 2024
Gastrointestinal Interventions
Henderson M. Jones, MD, JD
Fellow
Mayo Clinic Arizona
Financial relationships: Full list of relationships is listed on the CME information page.
Kristina Yancey, MD
Diagnostic Radiology Resident
Mayo Clinic Arizona
Financial relationships: Full list of relationships is listed on the CME information page.
Carleen Cuevas, BS
Medical Student
University of Arizona College of Medicine - Phoenix
Disclosure information not submitted.
Stephen Yao, BS
Medical Student
University of Arizona College of Medicine - Phoenix
Disclosure information not submitted.
Irving Jorge, MD MBA
Head of Acute Care Surgery
Mayo Clinic Arizona
Disclosure information not submitted.
Rahul Pannala, MD, MPH
Professor of Medicine
Mayo Clinic Arizona
Disclosure information not submitted.
Sadeer Alzubaidi, MD
Interventional Radiologist
Mayo Clinic
Financial relationships: Full list of relationships is listed on the CME information page.
Sailendra Naidu, MD
Interventional Radiologist
Mayo Clinic Arizona
Disclosure information not submitted.
Rahmi Oklu, MD, PhD (he/him/his)
Professor
Mayo Clinic Arizona
Financial relationships: Full list of relationships is listed on the CME information page.
Indravadan J. Patel, MD
Division Chief - Interventional Radiologist
Mayo Clinic Arizona
Financial relationships: Full list of relationships is listed on the CME information page.
Alex Wallace, MD
Interventional Radiologist
Mayo Clinic Hospital Florida
Disclosure information not submitted.
Grace Knuttinen, MD, PhD
Interventional Radiologist
Mayo Clinic Arizona
Disclosure information not submitted.
Enterocutaneous fistulae (ECF) are defined anatomically as abnormal connections between two epithelialized surfaces and can occur between the skin AND stomach, small bowel, or colon. Incidence directly correlates to etiology, of which up to 75-85% occur iatrogenically secondary to surgery. The remaining 15-25% can be attributed to local or systemic inflammation (i.e. Crohn’s, malignancy, radiation), trauma or ischemia. Mortality rates range widely from 10-30% and morbidity arises from creating an ideal environment for infection leading to local inflammation, electrolyte imbalances, and malnutrition of the digestive tract, and skin inflammation with necrosis. ECF are initially managed conservatively with wound care, pharmacotherapy, psychosocial and nutritional support. 30% of ECF will close spontaneously within the first 4 weeks; for the remaining 70%, a more invasive approach may be warranted. Surgical management is resection with anastomosis following sepsis control. Even with the appropriate preoperative optimization, success rates are about 50% and recurrence rates are high. Advanced Endoscopic management includes stent placement, clipping, endoscopic suturing, tissue sealants, endo-sponge or septal occluders. The success rates vary for each approach and are dependent on ECF location. Interventional Radiology offers evidence-based solutions to the challenges faced by our procedural colleagues in managing patients with ECF.
Clinical Findings/Procedure Details: Closure with Interventional Radiologic techniques is performed via a series of sequential steps to optimize procedural success and prevent recurrence. In general, fistulography is the initial step, with/without tissue debridement depending on the technique chosen. The various techniques and closure materials will be explored. Post-procedure follow-up care will also be emphasized.
Conclusion and/or Teaching Points: