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Endoscopic Fistulotomy: A Novel Technique in Patient With Inflammatory Bowel Disease: 2017 Presidential Poster Award


Kochhar, Gursimran MBBS, MD; Shen, Bo MD, FACG

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S451-S452
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Introduction: Fistula is one of the end complications, indicating advance disease phenotype in inflammatory bowel disease (IBD). Surgical fistulotomy, still by far remains a definitive treatment option, but fistulas can recur despite surgery and, moreover, surgeries carry a high risk of complications. Various endoscopic treatments have been tried in management of IBD related fistula's, with limited long term success. We here by describe a novel technique using endoscopic needle knife to perform endoscopic fistulotomy, in patients with IBD

Methods: A cohort of 29 consecutive patients with a fistula and IBD were identified in the registry of our interventional IBD unit. Various demographic and clinical data points were collected (Table 1). We performed all endoscopic procedures in our outpatient endoscopy suite, under conscious sedation. A 1.8-mm Microvasive needle knife (Boston Scientific) was used with electro incision to cut across the fistulous track separating the fistula from the lumen. Post procedure endoscopic hemoclips were placed along the opened fistula track to prevent reformation of the fistula. The primary outcome was healing of fistula without the need for surgical intervention

Table. Clinical and Demographic Variables

Results: A total of 29 patients underwent endoscopic fistulotomy, with a mean age of patients undergoing the procedure was 44.2 ± 14.6 years. Thirteen patients were male (44.8%), 28 (96.5%) were Caucasians. Twenty one (72.4%) patients had underlying ulcerative colitis (UC), 7 (24.1%) patients had underlying Crohn's disease (CD). Twenty six (89.6%) patients achieved a complete resolution of the fistula, confirmed by endoscopy with guide wire and/or CT enterography, with 10 patients (34.4%) requiring a single endoscopic session. Fourteen (48.2%) patients underwent one repeat endoscopic session. Three patients (10.3%) had a persistent fistula and required surgical intervention. One patient had post procedure bleeding requiring blood transfusion and hospitalization. There was no procedure-associated perforation.

Conclusion: In conclusion, fistulas in patients with IBD can be effectively and safely treated with endoscopic fistulotomy, in carefully selected patient population.

Endoscopic fistulotomy for pouch-pouch fistula. A. a pouch-to-pouch fistula from staple line leak was detected with a guide wire;B. Needle knife in action; C. Completed fistulotomy; D. Deployment of endoclips.
Table. Medication usage in relation to endoscopic procedure
© The American College of Gastroenterology 2017. All Rights Reserved.