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Mo1056 Over-the-Scope Clip for the Management of Enterocutaneous Fistula and Peristomal Leakage
Abstracts
very low as well as the overall morbidity and mortality rate. The need for prophylactic antibiotics to prevent early wound infection has not been proven. Keywords: PEG, enteral nutrition, tube feeding
Table 2. Follow up and Management of Clinical failure Follow up (days)
Recurrence
1 2 3
30 1 7
No No Yes
4 5 6 7 8
15 3 7 3 7
No No No No Yes
9 10
7 Died
11 12 13
3 1 3
Yes Non applicable (NA) No No Yes
14 15 16
7 3 3
Yes No No
patients
Mo1056 Over-the-Scope Clip for the Management of Enterocutaneous Fistula and Peristomal Leakage Majidah Bukhari*, Vivek Kumbhari, Saowanee Ngamruengphong, Yamile Haito Chavez, Yen-I. Chen, Ayesha Kamal, Gulara Hajiyeva, Amr Ismail, Mouen A. Khashab Johns Hopkins, Baltimore, MD Background: Enterocutaneous fistulae (ECF) can result from percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological jejunostomy (PRJ). The gold standard treatment of ECF is primary surgical closure which is invasive and carries a high risk of morbidity and mortality. The over-the-scope clip (OTSC) has been demonstrated to be effective and safe for leaks and perforations with its efficacy for fistulae closure being less well established. Aims: The aims of this study were to assess the technical success, clinical success, and adverse events of the OTSC in management of persistent ECF. Methods: We report a single center retrospective review of patients who underwent OTSC placement for ECF following gastrostomy or jejunostomy tube removal from 1/2012 to 11/2015. Persistent ECF was defined as persistent leakage for more than 1 week after removing the feeding tube. Technical success was defined as satisfactory application of the OTSC on the defect resulting in immediate fistula closure. Clinical success was defined as resolution of leakage after placement of the OTSC at last available follow-up. Adverse events were defined according to the ASGE Lexicon severity grading system. Results: A total 16 patients (mean age 54 year, 69% female) were included in the analysis. Fourteen patients had PEG tube placement and two had PRJ with a median time of percutaneous tube insertion of 22 months (range 1-120). The median duration of ECF was 21 days (range 7-60). The median size of the fistula was 10 mm (range 515). ECF was ablated with APC prior to OTSC placement in 87.5% of patients. Technical success was achieved in all patients (100%). The median follow up post OTSC placement was 7 days (range 3-30). Overall clinical success was accomplished in 62.5 % of cases (10/16 patients) without any adverse events. Six patients had clinical failure post placement of the OTSC. Two were managed successfully with alternative endoscopic therapies, 3 were managed surgically and 1 died of unrelated causes. Conclusions: Endoscopic closure of ECF using the OTSC with endoscopic ablation of the fistula tract is a moderately effective, safe and minimally invasive treatment modality. About two thirds of patients fail therapy and can be managed by alternative endoscopic or surgical modalities.
Clinical Success
Need for surgical closure
No No The OverStitch Endoscopic Suturing External APC and CYA No No No No The OverStitch Endoscopic Suturing Enteral stenting NA
Yes Yes Yes
No No No
Yes Yes Yes Yes No
No No No No Yes
Yes NA
No NA
No No The OverStitch Endoscopic Suturing No No No
Yes Yes No
No No Yes
Yes Yes Yes
No No No
Additional Endoscopic therapy
Mo1057 Early Endoscopy Lowers Mortality in Upper Gastrointestinal Bleeding Amitasha Sinha*, Rohit Anand, Anita Sivaraman, Michelle Le, Sudhir Dutta Division of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD Background: Recent studies have reported Gastrointestinal (GI) bleeding as the most common cause of hospitalization in United States. Upper GI bleeding remains a leading cause of morbidity and mortality. Although endoscopy is the
Table 1. Patient demographics and outcomes: Indication for enteral tube placement
Type of enteral tube
Duration of enteral tube placement (moths)
Age of Fistula prior to OTSC (days)
Prior endoscopic therapy
Diameter of fistula (mm)
Additional therapy with OTSC
Technical success
Clinical success
PRJ PEG PEGJ PEG PEG PEGJ PEGJ PEG PRJ PEG
24 24 36 36 6 11 2 5 20 48
21 21 18 30 7 8 7 21 21 30
No Hemoclips No No No No No No Hemoclips No
8 8 10 10 10 6 12 10 15 10
No No Glue No No No No Glue Glue No
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Yes Yes No Yes Yes Yes Yes No No No
PRGJ PEG
6 120
53 60
No Hemoclips
6 5
No Glue
Yes Yes
Yes Yes
PEGJ PEGJ
12 48
60 14
Hemoclips No
No Glue
Yes Yes
No No
24
30
No
Glue
Yes
Yes
7
No
Widening site (7) Widening site (10) Widening site (10) Widening site (10)
No
Yes
Yes
Age (year)
Sex
1 2 3 4 5 6 7 8 9 10
24 80 45 25 27 69 76 60 81 57
Female Female Female Male Female Male Female Female Female Male
11 12
17 41
Female Female
13 14
51 65
Male Male
Malnutrition Esophageal cancer Gastroparesis Malnutrition Malnutrition Gastroparesis Gastroparesis Malnutrition Malnutrition Neurological disorder Malnutrition Neurological disorder Malnutrition Gastroparesis
15
70
Female
Gastroparesis
PEG
16
35
Female
Esophageal cancer
PEG
patient
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1.5
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB445
very low as well as the overall morbidity and mortality rate. The need for prophylactic antibiotics to prevent early wound infection has not been proven. Keywords: PEG, enteral nutrition, tube feeding
Table 2. Follow up and Management of Clinical failure Follow up (days)
Recurrence
1 2 3
30 1 7
No No Yes
4 5 6 7 8
15 3 7 3 7
No No No No Yes
9 10
7 Died
11 12 13
3 1 3
Yes Non applicable (NA) No No Yes
14 15 16
7 3 3
Yes No No
patients
Mo1056 Over-the-Scope Clip for the Management of Enterocutaneous Fistula and Peristomal Leakage Majidah Bukhari*, Vivek Kumbhari, Saowanee Ngamruengphong, Yamile Haito Chavez, Yen-I. Chen, Ayesha Kamal, Gulara Hajiyeva, Amr Ismail, Mouen A. Khashab Johns Hopkins, Baltimore, MD Background: Enterocutaneous fistulae (ECF) can result from percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological jejunostomy (PRJ). The gold standard treatment of ECF is primary surgical closure which is invasive and carries a high risk of morbidity and mortality. The over-the-scope clip (OTSC) has been demonstrated to be effective and safe for leaks and perforations with its efficacy for fistulae closure being less well established. Aims: The aims of this study were to assess the technical success, clinical success, and adverse events of the OTSC in management of persistent ECF. Methods: We report a single center retrospective review of patients who underwent OTSC placement for ECF following gastrostomy or jejunostomy tube removal from 1/2012 to 11/2015. Persistent ECF was defined as persistent leakage for more than 1 week after removing the feeding tube. Technical success was defined as satisfactory application of the OTSC on the defect resulting in immediate fistula closure. Clinical success was defined as resolution of leakage after placement of the OTSC at last available follow-up. Adverse events were defined according to the ASGE Lexicon severity grading system. Results: A total 16 patients (mean age 54 year, 69% female) were included in the analysis. Fourteen patients had PEG tube placement and two had PRJ with a median time of percutaneous tube insertion of 22 months (range 1-120). The median duration of ECF was 21 days (range 7-60). The median size of the fistula was 10 mm (range 515). ECF was ablated with APC prior to OTSC placement in 87.5% of patients. Technical success was achieved in all patients (100%). The median follow up post OTSC placement was 7 days (range 3-30). Overall clinical success was accomplished in 62.5 % of cases (10/16 patients) without any adverse events. Six patients had clinical failure post placement of the OTSC. Two were managed successfully with alternative endoscopic therapies, 3 were managed surgically and 1 died of unrelated causes. Conclusions: Endoscopic closure of ECF using the OTSC with endoscopic ablation of the fistula tract is a moderately effective, safe and minimally invasive treatment modality. About two thirds of patients fail therapy and can be managed by alternative endoscopic or surgical modalities.
Clinical Success
Need for surgical closure
No No The OverStitch Endoscopic Suturing External APC and CYA No No No No The OverStitch Endoscopic Suturing Enteral stenting NA
Yes Yes Yes
No No No
Yes Yes Yes Yes No
No No No No Yes
Yes NA
No NA
No No The OverStitch Endoscopic Suturing No No No
Yes Yes No
No No Yes
Yes Yes Yes
No No No
Additional Endoscopic therapy
Mo1057 Early Endoscopy Lowers Mortality in Upper Gastrointestinal Bleeding Amitasha Sinha*, Rohit Anand, Anita Sivaraman, Michelle Le, Sudhir Dutta Division of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD Background: Recent studies have reported Gastrointestinal (GI) bleeding as the most common cause of hospitalization in United States. Upper GI bleeding remains a leading cause of morbidity and mortality. Although endoscopy is the
Table 1. Patient demographics and outcomes: Indication for enteral tube placement
Type of enteral tube
Duration of enteral tube placement (moths)
Age of Fistula prior to OTSC (days)
Prior endoscopic therapy
Diameter of fistula (mm)
Additional therapy with OTSC
Technical success
Clinical success
PRJ PEG PEGJ PEG PEG PEGJ PEGJ PEG PRJ PEG
24 24 36 36 6 11 2 5 20 48
21 21 18 30 7 8 7 21 21 30
No Hemoclips No No No No No No Hemoclips No
8 8 10 10 10 6 12 10 15 10
No No Glue No No No No Glue Glue No
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Yes Yes No Yes Yes Yes Yes No No No
PRGJ PEG
6 120
53 60
No Hemoclips
6 5
No Glue
Yes Yes
Yes Yes
PEGJ PEGJ
12 48
60 14
Hemoclips No
No Glue
Yes Yes
No No
24
30
No
Glue
Yes
Yes
7
No
Widening site (7) Widening site (10) Widening site (10) Widening site (10)
No
Yes
Yes
Age (year)
Sex
1 2 3 4 5 6 7 8 9 10
24 80 45 25 27 69 76 60 81 57
Female Female Female Male Female Male Female Female Female Male
11 12
17 41
Female Female
13 14
51 65
Male Male
Malnutrition Esophageal cancer Gastroparesis Malnutrition Malnutrition Gastroparesis Gastroparesis Malnutrition Malnutrition Neurological disorder Malnutrition Neurological disorder Malnutrition Gastroparesis
15
70
Female
Gastroparesis
PEG
16
35
Female
Esophageal cancer
PEG
patient
www.giejournal.org
1.5
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB445