Endoscopic closure of esophageal, gastric, jejunal, and rectopelvic fistulas with cardiac septal occluder devices: a case series

Background and Aims

Treating GI fistulas and anastomotic leaks is a challenge. Traditionally, these adverse events have been treated with conservative measures or surgical interventions, both of which have been associated with high rates of morbidity. Although endoscopic techniques are available and commonly minimally invasive, their success can be variable and oftentimes require repeat interventions. Cardiac septal occluder (CSO) devices have emerged as an alternative for managing these complex GI fistulas and anastomotic leaks after the more conservative endoscopic options fail.

Methods

Before the introduction of the CSO device into the body, a CSO delivery system must first be created. After integrating this system with an endoscope, argon plasma coagulation is used on each of the fistulas, and the CSOs are then deployed under fluoroscopy.

Cases

We present 4 cases of CSO device placement throughout the GI tract: in the esophagus, jejunum, stomach, and rectosigmoid colon. Each of these cases presents unique challenges in maneuvering the anatomy, ensuring the CSOs fully occlude the fistulas, and are successful in causing tissue in-growth postplacement.

Conclusions

This study presents a case series of 4 successful closures of GI fistulas using CSO devices after the failure of more conservative therapies. Each of these cases takes place in a different part of the GI tract—the esophagus, stomach, small intestines, and large intestines—indicating the broad application of CSO devices. CSOs offer a promising alternative for managing complex GI fistulas and postsurgical anastomotic leaks endoscopically throughout the entire GI tract.