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V.01.6: Ileo-Duodenal Fistula in Crohn’s Disease Successfully Treated with an Ovesco Clip (with Video)
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Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
Material and methods: This new technique consists in introducing gastroscope through the stomach instead of mouth. It may be placed both using percutaneous endoscopic gastrostomy (PEG) already placed both as first insert using the “Introducer” technique. When PEG is already placed, the PEJ placement may occur through the gastrostomy. In case of the first implant, stomach is fixed to abdominal wall by 3–4 clips. After using a Seldinger needle to penetrate into the stomach, a retractor called “introducer” is placed, and the gastroscope passes through it up to Treiz angle. A guidewire is positioned though bioptic channel and under Rx fluoroscopy: if it is correctly placed, gastroscope is therefore retired, and the jejunostomic tube is placed through the guidewire (still under Rx fluoroscopy control) according to the standard procedure. Results: This technique has several advantages than standard procedure: a larger tube (20–22 French vs. 8–12) excludes occlusions and permits to drain gastric retention; permits to place correctly jejunoscopic tube at the Treiz angle, reducing significantly the risk of ab ingestis and peri-stomitis because of gastric retention; the control under Rx fluoroscopy permits to correct kinking of the tube. Conclusions: This new technique may be advised in patients in whom transoral endoscopic jejunostomy cannot be apply or whether patients are at high risk of complication under standard transoral endoscopic jejunostomy placement.
V.01.6 ILEO-DUODENAL FISTULA IN CROHN’S DISEASE SUCCESSFULLY TREATED WITH AN OVESCO CLIP (WITH VIDEO) L. Poliani ∗ , R. Maselli, P.A. Galtieri, A. Fugazza, G. Lollo, F. Auriemma, R. Semeraro, G. Amvrosiadis, S. Carrara, M. Di Leo, A. Anderloni, E.C. Ferrara, A. Repici Humanitas Researc Hospital, Rozzano (MI), Italy Background and aim: The transmural inflammatory nature of
Crohn’s disease (CD) predisposes to the formation of fistulae (14% CD patients had penetrating disease at diagnosis and the risk for developing fistula is 40–70% at 10 y after diagnosis). Various endoscopic techniques have been used in the management of CD-associated fistulas including closure with endoclips. The OTSC (OVESCO clip) is a novel and safe endoscopic tool used in the non-surgical treatment of gastrointestinal perforations, fistulae and anastomotic leaks. Few reports are present on its use in CD-related fistula; we describe a case of ileo-duodenal fistula in CD successfully treated with OVESCO. Material and methods: This is a case of a 40-year-old man with a history of stenotic and fistulising CD with ileum-colic localization which required ileal resection and ileo-colic anastomosis. During follow-up the patient performed an abdominal MRI with contrast, which documented active disease conditioning stricture of new terminal ileum and fistula between the new terminal ileum and the II portion of the duodenum. The patient was admitted to our unit for attempted endoscopic closure of the fistula for persistence of diarrhea (10 intestinal discharges per day) and weight loss. Results: After pneumatic dilation of the pylorus up to 18 mm, with an operative gastroscope loaded with OTSC system, OVESCO Clip (Endoscopy GmbH, Tübingen, Germany), we reached the fistula located on the posterior wall of the second duodenal portion and we proceeded to the placement of Ovesco clip (21 mm in diameter). At the end of the procedure we evaluated the correct placement under endoscopic and radiological control with direct passage of Gastrografin in the proximal jejunum without any leak. No periprocedural complications were registered and the patient was discharged after few hours. During the subsequent follow up he reported marked improvement in diarrhea and progressive weight recovery. Conclusions: The application of OTSC appears to be useful in the endoscopic management of fistulae and leaks, with a high success rates reported in the literature. Our case demonstrates the safety and effectiveness of this device to treat duodenal CD-related fistula.
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
Material and methods: This new technique consists in introducing gastroscope through the stomach instead of mouth. It may be placed both using percutaneous endoscopic gastrostomy (PEG) already placed both as first insert using the “Introducer” technique. When PEG is already placed, the PEJ placement may occur through the gastrostomy. In case of the first implant, stomach is fixed to abdominal wall by 3–4 clips. After using a Seldinger needle to penetrate into the stomach, a retractor called “introducer” is placed, and the gastroscope passes through it up to Treiz angle. A guidewire is positioned though bioptic channel and under Rx fluoroscopy: if it is correctly placed, gastroscope is therefore retired, and the jejunostomic tube is placed through the guidewire (still under Rx fluoroscopy control) according to the standard procedure. Results: This technique has several advantages than standard procedure: a larger tube (20–22 French vs. 8–12) excludes occlusions and permits to drain gastric retention; permits to place correctly jejunoscopic tube at the Treiz angle, reducing significantly the risk of ab ingestis and peri-stomitis because of gastric retention; the control under Rx fluoroscopy permits to correct kinking of the tube. Conclusions: This new technique may be advised in patients in whom transoral endoscopic jejunostomy cannot be apply or whether patients are at high risk of complication under standard transoral endoscopic jejunostomy placement.
V.01.6 ILEO-DUODENAL FISTULA IN CROHN’S DISEASE SUCCESSFULLY TREATED WITH AN OVESCO CLIP (WITH VIDEO) L. Poliani ∗ , R. Maselli, P.A. Galtieri, A. Fugazza, G. Lollo, F. Auriemma, R. Semeraro, G. Amvrosiadis, S. Carrara, M. Di Leo, A. Anderloni, E.C. Ferrara, A. Repici Humanitas Researc Hospital, Rozzano (MI), Italy Background and aim: The transmural inflammatory nature of
Crohn’s disease (CD) predisposes to the formation of fistulae (14% CD patients had penetrating disease at diagnosis and the risk for developing fistula is 40–70% at 10 y after diagnosis). Various endoscopic techniques have been used in the management of CD-associated fistulas including closure with endoclips. The OTSC (OVESCO clip) is a novel and safe endoscopic tool used in the non-surgical treatment of gastrointestinal perforations, fistulae and anastomotic leaks. Few reports are present on its use in CD-related fistula; we describe a case of ileo-duodenal fistula in CD successfully treated with OVESCO. Material and methods: This is a case of a 40-year-old man with a history of stenotic and fistulising CD with ileum-colic localization which required ileal resection and ileo-colic anastomosis. During follow-up the patient performed an abdominal MRI with contrast, which documented active disease conditioning stricture of new terminal ileum and fistula between the new terminal ileum and the II portion of the duodenum. The patient was admitted to our unit for attempted endoscopic closure of the fistula for persistence of diarrhea (10 intestinal discharges per day) and weight loss. Results: After pneumatic dilation of the pylorus up to 18 mm, with an operative gastroscope loaded with OTSC system, OVESCO Clip (Endoscopy GmbH, Tübingen, Germany), we reached the fistula located on the posterior wall of the second duodenal portion and we proceeded to the placement of Ovesco clip (21 mm in diameter). At the end of the procedure we evaluated the correct placement under endoscopic and radiological control with direct passage of Gastrografin in the proximal jejunum without any leak. No periprocedural complications were registered and the patient was discharged after few hours. During the subsequent follow up he reported marked improvement in diarrhea and progressive weight recovery. Conclusions: The application of OTSC appears to be useful in the endoscopic management of fistulae and leaks, with a high success rates reported in the literature. Our case demonstrates the safety and effectiveness of this device to treat duodenal CD-related fistula.