SIR 2024
Gastrointestinal Interventions
Jeffrey Girardot, BS
Medical Student
Case Western Reserve University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Nicholas Xiao, MD
Chief Resident, Integrated IR
Division of Interventional Radiology, Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Heather Molina, PA
Physician Assistant, Department of Vascular and Interventional Radiology
Northwestern Medicine
Disclosure information not submitted.
Scott Resnick, MD
Attending Physician
Northwestern Memorial Hospital
Disclosure information not submitted.
Enterocutaneous fistulae are serious complications of bowel injury that significantly decrease life quality. While operative treatments exist, they neglect patients who are not surgical candidates or have failed operative therapy. One nonoperative method of fistula closure is the percutaneous placement of an extracellular matrix enterocutaneous fistula plug (ECMFP), which occupies the fistula tract and constructs a surface into which the fistula heals.
Materials and methods:
This study included 10 patients who had a Biodesign Fistula Plug (Cook Biotech Inc, West Lafayette, IN), placed for attempted fistula closure between June 2017 to July 2022 with follow-up through October 2022. Median patient age was 66.5 years. Patient characteristics are given in Table 1. Descriptive statistics were used to define fistula closure and failure.
Results:
Of the 10 patients included in this study, 5 achieved fistula closure (50%). Closure occurred in 3 of 4 enterocutaneous (75%), 1 of 1 gastrocutanous, and 1 of 5 colocutaneous fistulas (20%). Median time to closure was 1 month. Successfully closed fistulas had a mean duration of existence prior to plug placement of 4.6 months. Failed closures had a mean duration of existence of 15.3 months. Fistulae originating from a percutaneous enteric tube, either a gastrostomy, ileostomy, or colojejunostomy, had success in 2 of 3 patients (66%). Fistulae due to diverticulitis did not achieve closure (0 of 3).
Conclusion:
ECMFPs are a viable option to consider in patients with few other treatment options. These devices are useful for closure of refractory fistulae, especially involving the stomach or small bowel with existence of less than 1 year. Patients with colonic fistulae, patients that have had fistulae for longer than 1 year, or patients whose fistulae are due to diverticulitis are less likely to see successful closure with the ECMFP.