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Background: The Endoscopic Purse-string Suture (EPSS) technique has gained attention for its potential in closing large defects following gastrointestinal procedures. However, its application in fistula closure is not as widely reported. This study aims to evaluate the safety and efficacy of EPSS and naso-jejunal tube feeding in the closure of duodenal cutaneous fistulas and gastric cutaneous fistulas. Methods: This single-center retrospective study, conducted from September 2020 to September 2023 at Tongji University in Shanghai, China, examined the outcomes of EPPS and nasojejunal feeding for patients with gastric and duodenal cutaneous fistulas (n = 10). Demographic data, fistula characteristics, procedure technique and outcomes were evaluated. Results: In this study, the average size of a fistula opening was 7.9 ± 4.6 mm. The operations took an average of 25.8 ± 5.6 min. Patients typically needed naso-jejunal tube feeding for a median of 14.0 days, with an interquartile range (IQR) of 7.7–19.0 days. The median duration of hospital stay post-operation was 16.5 days, with an IQR of 7.0–25.0 days. Nine patients were successful in their initial fistula closure using the EPSS technique. The other patient underwent a second EPSS and, ultimately, all patients experienced complete healing and fully recovered. There were no major adverse events reported. Conclusions: EPSS and naso-jejunal tube feeding are a safe and effective treatment option for duodenal and gastric cutaneous fistulas. Larger, prospective studies are needed to validate these findings and establish the long-term safety and efficacy of this approach. [ABSTRACT FROM AUTHOR]

Background: Percutaneous endoscopic gastrostomy is commonly used for enteral nutritional access, but gastrocutaneous fistulae (GCF) may persist after tube removal, posing clinical challenges. The use of endoscopic closure devices, including over-the-scope clips (OTSC), has shown promise in managing non-healing fistulae, although data in the pediatric population are limited. Methods: A retrospective multicenter study analyzed pediatric patients who underwent GCF closure following gastrostomy tube removal. Data from seven centers across multiple countries were collected, including patient demographics, procedural details, complications, and outcomes. Closure techniques were compared between OTSC and surgical closure. Results: Of 67 pediatric patients included, 21 underwent OTSC closure and 46 had surgical closure. Surgical closure demonstrated a higher success rate (100%) compared to OTSC closure (61.9%, P < 0.001). While procedural duration was shorter for OTSC closure (25 vs. 40 min, P = 0.002), complications, and scar quality were comparable between techniques. A subsequent sub-analysis did not reveal differences based on center experience. Conclusion: OTSC closure is feasible and safe in pediatric patients, but surgical closure remains superior in achieving sustained GCF closure, although OTSC offers benefits, such as shorter procedural duration, potentially reducing the duration of general anesthesia exposure. Non-operative approaches, including OTSC, may be a valuable alternative to surgical closure. [ABSTRACT FROM AUTHOR]

Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including endoscopic vacuum therapy, VacStent therapy, endoscopic internal drainage with pigtail stents, endoscopic suturing and stem cell injection. In this narrative review, we shed light on recent literature, developments, indications and contraindications of these treatments. Intragastric gastric band migration is a rare complication after gastric band positioning. Reoperation can sometimes be difficult, especially when a gastric band has already migrated far into the stomach. Endoscopic retrieval can be a valid, non-invasive therapeutic solution. We reviewed the current literature on this matter. [ABSTRACT FROM AUTHOR]

Duodenal stump fistula (DSF) is a dangerous complication after gastrectomy. There is no consensus on the management of DSF. Sometimes, emergency surgery may be necessary. We present the case who underwent subtotal gastrectomy with Roux-en-Y reconstruction for advanced gastric cancer. After that surgery, we diagnosed DSF due to pancreatic fistula, and performed reoperation because of hemodynamic instability due to diffuse peritonitis and sepsis. We resected the stump and closed with handsewn suturing and inserted three intra-abdominal drainage tubes, including a dual drainage tube around the duodenal stump. Although there was a recurrence of DSF, because of the continuous and absolute drainage, the patient improved and discharged on postoperative Day 59. From this experience, diligent debridement and a continuous suction dual drainage system, intraluminal drain of the duodenum, and biliary diversion may be an effective surgical management for DFS. [ABSTRACT FROM AUTHOR]

This article reports on a case of a 61-year-old male with rectal cancer who developed a gastrohepatic fistula after undergoing radiation segmentectomy for liver metastases. The patient initially received chemotherapy and underwent right hepatic lobectomy and lower anterior resection of the primary tumor. Radiation segmentectomy was performed due to the size and location of the metastasis. However, three months after the procedure, the patient developed a liver abscess related to a gastrohepatic fistula. Surgical interventions were performed, but the patient eventually died from disease progression and liver failure. The article suggests that spacing-protective techniques should be considered in cases where high-dose radioembolization is planned, and the irradiated liver volume is near adjacent organs. The potential role of bevacizumab in fistula formation is also mentioned. [Extracted from the article]

Background: Leaks following bariatric surgery, while rare, are potentially fatal due to risk of peritonitis and sepsis. Anastomotic leaks and gastro-gastric fistulae following Roux-En-Y gastric bypass (RYGB) as well as staple line leaks after sleeve gastrectomy have historically been treated multimodally with surgical drainage, aggressive antibiotic therapy, and more recently, endoscopically. Endoscopic clipping using over-the-scope clips and endoscopic suturing are two of the most common approaches used to achieve full thickness closure. Methods: A systematic literature search was performed in PubMed to identify articles on the use of endoscopic clipping or suturing for the treatment of leaks and fistulae following bariatric surgery. Studies focusing on stents, and those that incorporated multiple closure techniques simultaneously, were excluded. Literature review and meta-analysis were performed with the PRISMA guidelines. Results: Five studies with 61 patients that underwent over-the-scope clip (OTSC) closure were included. The pooled proportion of successful closure across the studies was 81.1% (95% CI 67.3 to 91.7). The successful closure rates were homogeneous (I2 = 39%, p = 0.15). Three studies with 92 patients that underwent endoscopic suturing were included. The weighted pooled proportion of successful closure across the studies was shown to be 22.4% (95% CI 14.6 to 31.3). The successful closure rates were homogeneous (I2 = 0%, p = 0.44). Three of the studies, totaling 34 patients, examining OTSC deployment reported data for reintervention rate. The weighted pooled proportion of reintervention across the studies was 35.0% (95% CI 11.7 to 64.7). We noticed statistically significant heterogeneity (I2 = 68%, p = 0.04). One study, with 20 patients examining endoscopic suturing, reported rate of repeat intervention 60%. Conclusion: Observational reports show that patients managed with OTSC were more likely to experience healing of their defect than those managed with endoscopic suturing. Larger controlled studies comparing different closure devices for bariatric leaks should be carried out to better understand the ideal endoscopic approach to these complications. [ABSTRACT FROM AUTHOR]

Background: In recent years, Raoultella ornithinolytica (R. ornithinolytica) have attracted clinical attention as a new type of pathogen. A wide range of infections with these germs is reported, and commonly found in urinary tract infections, respiratory infections, and bacteremia. Case presentation: We report the case of an elderly woman with liver abscess, choledocholithiasis and cholangitis, who developed gastric fistula and abdominal abscess after underwent choledocholithotomy, and R. ornithinolytica were isolated from the abdominal drainage fluid. The patient was treated with meropenem and levofloxacin and had a good outcome. Conclusions: To the best of our knowledge, case of isolating R. ornithinolytica from a patient with non-viscerally abdominal abscess was extremely rare. We share a case of a woman with non-viscerally abdominal abscess secondary to postoperative gastric fistula, R. ornithinolytica was isolated from the patient's pus, and the pathogenic bacteria may originate from the gastrointestinal tract. Based on this case, We should be cautious that invasive treatment may greatly increase the probability of infection with this pathogenic bacterium. [ABSTRACT FROM AUTHOR]

Gastric perforations and leaks are significant complications that can arise from various gastrointestinal disorders and surgical interventions. Over the past decade, endoscopic techniques have emerged as an effective method for managing these conditions. Furthermore, as endoscopic resection techniques have grown in popularity, the risk of acute and delayed perforations has also grown. This review aims to provide an in-depth analysis of the endoscopic management strategies employed in the management of gastric perforations and leaks. We will discuss the etiology, diagnostic modalities, and various endoscopic techniques utilized, as well as emerging trends in endoscopic management. Our attempt in writing this review paper is to educate and guide clinicians in making informed decisions when faced with gastric perforations and leaks. [ABSTRACT FROM AUTHOR]

Pneumopericardium secondary to gastro-pericardial fistula is a rare complication associated with various surgical procedures and conditions, notably Roux-en-Y gastric bypass. This condition poses a risk of cardiac tamponade and can be fatal if not promptly diagnosed and managed. We present a case of a 62-year-old female with a history of gastric bypass who presented with nonspecific symptoms and was eventually diagnosed with pneumopericardium secondary to gastro-pericardial fistula. Despite efforts for timely intervention, including transfer to a facility with cardiothoracic surgery availability, the patient's unstable condition precluded surgical intervention, leading to her eventual demise. A literature review reveals that the average time from Roux-en-Y gastric bypass surgery to presentation is nine years. The elusive nature of the presentation underscores the importance of a comprehensive clinical history in identifying this condition early. Awareness of gastro-pericardial fistula as a potential late complication of gastric bypass is crucial for timely diagnosis and intervention to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Bouveret syndrome is the rarest variant of gallstone ileus characterized by the passage and impaction of a gallstone through a bilioenteric fistula leading to gastric outlet obstruction. The documented movement of an impacted gallstone in Bouveret syndrome through the gastrointestinal tract has not been previously discussed in the literature. A 64-year-old man presented with acute on chronic epigastric pain, fevers, and vomiting. Abdominal computed tomography established a diagnosis of Bouveret syndrome. A trial of endoscopic gallstone extraction was unsuccessful. Laparoscopic gastrotomy and stone removal were later attempted, however, intraoperatively it was noted that the stone had migrated and was now impacted in the jejunum causing a small bowel obstruction. The clinical picture was now that of gallstone ileus. Laparoscopic enterolithotomy was performed successfully. This article discusses the radiological, endoscopic, and intraoperative findings in this rare case of Bouveret syndrome that had evolved into classical gallstone ileus following stone migration. [ABSTRACT FROM AUTHOR]

Since the early 1990's, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although gastro‐pleural fistulas after bariatric surgeries are rare, they are life‐threatening complications that should be suspected in patients who present with gastrointestinal or respiratory symptoms after bariatric surgery. Previous studies showed an incidence rate of 0.2%–0.37% for gastro‐pleural fistulas after bariatric surgery. We report a 56‐year‐old female with a rare presentation of gastro‐pleural fistula after Roux‐en‐Y gastric bypass, simultaneous fistula of the gastric pouch, and remnant to the pleural space. [ABSTRACT FROM AUTHOR]

We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

Purpose: Necrotizing pancreatitis (NP) complicated by gastrointestinal fistula is challenging and understudied. As the treatment of necrotizing pancreatitis changed to a step-up strategy, we attempted to evaluate the incidence, risk factors, clinical outcomes and treatment of gastrointestinal fistulas in patients receiving a step-up approach.Methods: Clinical data from 1274 patients with NP from 2014– 2022 were retrospectively analyzed. Multivariable logistic regression analysis was conducted to identify risk factors and propensity score matching (PSM) to explore clinical outcomes in patients with gastrointestinal fistulas.Results: Gastrointestinal fistulas occurred in 8.01% (102/1274) of patients. Of these, 10 were gastric fistulas, 52 were duodenal fistulas, 14 were jejunal or ileal fistulas and 41 were colonic fistulas. Low albumin on admission (OR, 0.936), higher CTSI (OR, 1.143) and invasive intervention prior to diagnosis of gastrointestinal fistula (OR, 5.84) were independent risk factors for the occurrence of gastrointestinal fistula, and early enteral nutrition (OR, 0.191) was a protective factor. Patients who developed a gastrointestinal fistula were in a worse condition on admission and had a poorer clinical outcome (p< 0.05). After PSM, both groups of patients had similar baseline information and clinical characteristics at admission. The development of gastrointestinal fistulas resulted in new-onset persistent organ failure, increased open surgery, prolonged parenteral nutrition and hospitalization, but not increased mortality. The majority of patients received only conservative treatment and minimally invasive interventions, with 7 patients (11.3%) receiving surgery for upper gastrointestinal fistulas and 11 patients (26.9%) for colonic fistulas.Conclusion: Gastrointestinal fistulas occurred in 8.01% of NP patients. Independent risk factors were low albumin, high CTSI and early intervention, while early enteral nutrition was a protective factor. After PSM, gastrointestinal fistulas resulted in an increased proportion of NP patients receiving open surgery and prolonged hospitalization. The majority of patients with gastrointestinal fistulas treated with step-up therapy could avoid surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare the outcomes between patients with cirrhosis and those without who have undergone pancreatoduodenectomy (PD) in our institution. Methods: A review of patients undergoing PD from the time period of January 2010 to December 2020 was performed. Patients that have undergone open or laparoscopic PD and had liver cirrhosis diagnosed prior to surgery were included and matched on a 1:2 basis with non-cirrhotic patients based on age, gender, Eastern Cooperative Oncology Group (ECOG), and date of surgery. Data was obtained from our medical records and ten major postoperative complications variables were compared to the matched group. Results: Overall, 16 patients with cirrhosis were compared to 32 matched controls. No significant differences were found in pancreatic fistula (18.8% vs. 21.8%; P= 1.000), hemorrhage (6.3% vs. 6.2%; P= 1.000), delayed gastric emptying (6.3% vs. 15.6%; P= 0.648), wound infection (0% vs. 9.3%; P= 0.541), and intraabdominal abscess (31.2% vs 6.2%; 0.4998) for cirrhotic vs. non-cirrhotic respectively. There were no postop ileus, gastric fistula, mesenteric portal thrombosis, biliary fistula, and abdominal ischemic event in either group. The average length of stay for both groups was similar (6.9 vs. 9.3 days; P= 0.4019). There were no mortalities and major morbidity was similar (37.5% vs 34.3%; P=0.3549). One patient required readmission for liver-related decompensation with full recovery. Conclusion: PD in patients with cirrhosis can be safe and feasible in well-selected patients. In a high-volume institution, postoperative complications are similar to those patients without cirrhosis of the liver. [ABSTRACT FROM AUTHOR]

Background: Tracheobroncho-gastric fistula (TGF), a rare but potentially fatal complication following esophagectomy with gastric conduit reconstruction, has conventionally been treated with surgical repair and/or airway stenting. However, satisfactory therapeutic outcomes with these modalities have yet to be obtained because of difficulty in controlling persistent inflammation caused by digestive juice reflux. Case presentation: We adopted duodenal diversion (DD), a classic anti-reflux surgical method, as an additional option for TGF management and have experienced two cases undergoing DD surgery for post-esophagectomy TGF (all male, 76–77 years old). TGF was developed after gastric conduit necrosis and anastomotic leakage, respectively, in these patients. In both cases, the DD procedure combined with surgical fistula repair was feasible with no DD-related complications. These operations achieved a good effect in terms of preventing gastroduodenal reflux and ameliorating respiratory status. Reconstructive surgery after DD was performed and oral dietary intake was successfully resumed in one case. Conclusion: DD appears to be a valid evacuation therapy when airway contamination with gastroduodenal reflux is not amenable to the conventional approach alone, and can usefully be included in the TGF treatment strategy in appropriate cases. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Fistulas involving the stomach and duodenum in Crohn's disease are rare (occurring in less than 1% of patients). Here, we reviewed registers from 855 patients with Crohn's disease treated in our service from January 2007 to December 2020 and found 4 cases of duodenal fistula and 1 case of gastric fistula. Case Reports: The fistula origin was in the ileocolic segment in all cases, and all of the patients underwent preoperative optimization with improvement of nutritional status and infection control. They then underwent surgical treatment with resection of the affected segment and duodenal or gastric closure with covering by an omental patch. One case of a duodenal fistula was complicated by duodenal dehiscence. This was treated surgically with duodenojejunostomy. Each of the other patients had an uneventful postoperative course. All patients were successfully cured of their gastroduodenal fistulas, and at the time of this publication, none of them died or had fistula recurrence. Conclusions: Fistulas with the involvement of the stomach and duodenum in patients with Crohn's disease are almost always due to inflammation in the ileum, colon, or previous ileocolic anastomosis. Management of this situation is complex and often requires clinical and surgical assistance; preoperative optimization of the patient's general condition can improve the surgical results. The surgical approach is based on resection of the affected segment and gastric or duodenal closure with covering by an omental patch. Gastrojejunostomy or duodenojejunostomy can be performed in selected patients with larger defects and minor jejunal disease. To prevent recurrence, prophylactic therapy with anti-TNF agents and early endoscopic surveillance are also essential for successful treatment. [ABSTRACT FROM AUTHOR]

The article discusses a case study where a 59-year-old man with an esophagogastric anastomotic fistula following cancer surgery was successfully treated with complete endoscopic debridement and partial gastric wall resection. The patient had previously undergone treatment with a "three-tube" method without improvement. After the new treatment, surveillance endoscopy showed complete healing of the fistula after 17 months, with a weight gain of 9 kg during follow-up. The authors suggest that this method is safe and effective for treating refractory anastomotic fistulas. [Extracted from the article]

This article discusses a rare case of a 29-year-old Tibetan male who experienced severe upper gastrointestinal bleeding. The patient had a history of surgery for hepatic echinococcosis and pancreatitis. Initial tests suggested a pancreatic pseudocyst, but during an emergency exploratory laparotomy, a bleeding site beneath the cardia was found, which was identified as an intra-abdominal hydatid cyst. The cyst had perforated into the stomach, causing the bleeding. Despite surgical intervention, the patient unfortunately died of shock due to a massive rehemorrhage. This case highlights the unusual complications that can arise from intra-abdominal hydatid disease and emphasizes the importance of collaboration between gastroenterologists and surgeons in identifying and treating such cases. [Extracted from the article]

Background: Gastrosplenic fistula (GSF) is a rare complication of various benign and malignant etiologies. Splenic lymphoma is the most common cause of GSF. Most cases are due to diffuse large B-cell lymphoma (DLBCL). Case presentation: A 39-year-old male patient presented at the emergency department with left upper quadrant abdominal pain. CT scan showed necrotic splenic mass with fistulous tract between the spleen and the gastric cavity. The patient underwent splenectomy and partial gastrectomy. The histopathological diagnosis was DLBCL. Conclusions: Gastrosplenic fistula is a rare complication of diffuse large B-cell lymphoma. Radiologists should be aware of it and consider it in the diagnosis. [ABSTRACT FROM AUTHOR]

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Objectives: To compare the effectiveness and safety of transgastric and transrectal pure natural orifice transluminal endoscopic surgery (NOTES) for cholecystolithotomy. Methods: This was a single‐center retrospective comparative study of consecutive patients who underwent pure NOTES for either transrectal or transgastric gallbladder‐preserving cholecystolithotomy between September 2017 and April 2020. Patients with symptomatic cholelithiasis were assigned for transrectal or transgastric NOTES based on the patients' choice. Treatment success, postoperative pain, peritonitis, time to resume normal diet, and duration of hospitalization were compared. Results: The technical success rate was 100%. Forty‐eight patients underwent successful NOTES cholecystolithotomy via the transrectal (n = 26) or transgastric route (n = 22). One (3.8%) patient in the transrectal NOTES group experienced postoperative abdominal pain compared to 6 (27.3%) in the transgastric NOTES group (P = 0.04). Fever and bile peritonitis developed in one (3.8%) patient in the transrectal NOTES group versus 8 (36.4%) in the transgastric NOTES group (P = 0.005). A postoperative fluid diet was commenced at 6 h with the transrectal approach versus on day 3 for the transgastric NOTES group. The mean postoperative hospitalization for transrectal and transgastric NOTES groups was 4.5 days versus 7 days (P = 0.001). Three patients in the transgastric NOTES group developed postoperative gastric fistula. Conclusions: Transrectal NOTES has advantages over transgastric NOTES, including preserved spatial orientation, relatively easier removal of specimens, early food intake, shorter hospitalization, fewer postoperative complications and less pain. Multicenter clinical trials with long‐term follow‐up are needed to confirm the safety and efficacy of both approaches. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effectiveness of a novel method to identify occult cystobiliary fistulas and prevent leakage. Twenty-four patients diagnosed with liver hydatid cyst who were treated in our clinic between April 2017 and December 2020 were evaluated for inclusion into the study. After opening the cyst from the dome, removing the cyst contents, and performing cholecystectomy, the entire biliary tree was filled with parenteral lipid solution through a catheter inserted in the cystic duct (Omegaven® 10%, Fresenius Kabi) in order to evaluate occult and repaired fistulas. Thirteen (65%) of the 20 patients included in the study were female and seven (35%) were male. Twelve (60%) patients had solitary lesions, and eight (40%) patients had multiple cysts. Bile contamination was observed in the cyst cavity during cystotomy in nine (45%) patients. In two (10%) patients, bile contamination was observed in sponges placed in the cavity following cyst evacuation. Bile leakage was not observed in the intra- or postoperative periods in any of the patients as a result of repairs involving the application of a pressurised lipid solution to the bile tree through a catheter in the cystic duct. The technique applied in this article made it possible to detect all fistulas between the cyst and biliary tract during surgery and to check our results after completion of necessary repairs. Although the results of our study are positive, many studies are now needed on this subject. [ABSTRACT FROM AUTHOR]

Gastrocardiac fistula is a rare, typically fatal, diagnosis which has been reported infrequently in post-esophagectomy patients and, to a much lesser extent, patients with history of Roux-en-Y gastric bypass. This case describes a patient with a history of an eroded adjustable gastric band and subsequent removal with conversion to Roux-en-Y gastric bypass that initially presented with an upper gastrointestinal bleed. She was found to have a transdiaphragmatic fistula between the gastric lumen and left ventricle. [ABSTRACT FROM AUTHOR]

Abstract Background Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula. Materials and methods 82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His. Results In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients’ group. Conclusion Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion. Trial registration Retrospectively registrated

Introduction: Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascular defects, including gastrointestinal (GI) disruptions. Previous case reports have reported similar results with the CSDO Amplatzer™ for the management of GI disruptions following bariatric surgery. However, the use of similar alternative devices for this purpose has not yet been described. Case Presentation: This case report presents the first reported use of the Occlutech® CSDO for the treatment of a chronic gastrocutaneous fistula after bariatric revisional surgery. Despite apparent initial success – no extravasation of contrast material through the device in the contrast study after the CSDO placement – fistula closure failed due to partial dislodgement of the device. The placement of a second device between the discs of the former one ultimately sealed the fistulous orifice. Discussion: In chronic GI fistulas, the mature tract is often not liable to the application of standard endoscopic methods, leading to failed closure attempts. A new application of Occlutech® CSDO can obviate the clinical burden of a high-risk laparotomy in these cases. Appropriate endoscopic equipment as well as the involvement of a multidisciplinary team are prime conditions to ensure successful patient outcomes.

Background: With the increasing incidence of upper digestive tract tumors, more upper digestive tract surgeries are performed each year, and surgeons have difficulty in the postoperative management of gastrointestinal anastomotic fistula. The use of a new minimally invasive technique, endoluminal vacuum-assisted closure (E-VAC), has increased the success rate of the treatment of gastrointestinal fistula. Methods: We present 6 cases of gastrointestinal fistula treated in our hospital in 2021: 3 cases of anastomotic fistula after esophageal cancer surgery, 2 cases of anastomotic fistula after gastric cancer surgery, and one case of esophageal rupture after trauma. With E-VAC and other adjuvant treatment measures, the gastrointestinal fistulas were eventually closed or significantly reduced. Results: Both local and systemic infections in all 6 patients were controlled with the use of E-VAC device, resulting in significant reduction or closure of fistulas. Conclusion: E-VAC devices can effectively help in the removal of the exudate and necrotic tissue around the fistula, promote the proliferation of granulation tissue, and support closure of the fistula. However, further improvements to the device are needed to improve patient comfort and operational safety. [ABSTRACT FROM AUTHOR]

Gastrocolic fistula is a rare complication of the percutaneous endoscopic gastrostomy (PEG) placement procedure. This complication occurs due to penetration of interposed colon when a PEG tube is placed into the stomach. It can go unrecognized, becoming evident only when a tube replacement is performed or tube migration occurs. We report a case of severe, intractable diarrhea occurring about one month after the PEG procedure in a patient with severe traumatic brain injury. We present our case and discuss its significance with the aim of raising clinicians' awareness of this rare condition. [ABSTRACT FROM AUTHOR]

The article discusses a case of Bouveret syndrome, which is an unusual form of gallstone ileus caused by an acquired fistula between the gallbladder and either the duodenum or stomach. The case presented a 37-year-old woman with nonbilious vomiting and acute-onset right-sided abdominal pain, which was caused by an ectopic impacted gallstone leading to gastric outlet obstruction.

Background: The purpose of this study was to investigate the effect of our revamped MIE-McKeown operation on postoperative gastrointestinal function recovery. Methods: This revamped MIE-McKeown operation without removing azygos vein arch, bronchial artery and vagus nerve trunk and with the tubular stomach buried throughout esophageal bed and azygos arch, has been implemented from July 2020 to July 2021 by the same medical team of Gaozhou People's Hospital thoracic surgery for 13 times. Preoperative clinical data, main intraoperative indicators and postoperative complications were observed. Results: All patients had esophageal malignant tumors at the level of middle and lower thoracic non-azygous venous arch, with preoperative clinical stage CT1-2N0M0 stage i-ii. V-vst test was performed on the 7th postoperative day, and 10 patients were found to have no loss of safety/efficacy. There were 2 cases with impaired efficacy and no impaired safety, 1 case with impaired safety. There were 1 cases of pulmonary infection, 1 cases of anastomotic fistula combined with pleural and gastric fistula, 2 cases of hoarseness, 2 cases of arrhythmia, 10 cases of swallowing function were grade i, 2 cases of swallowing function were grade iii, 1 case of swallowing function was grade iv in watian drinking water test one month after operation. Conclusions: Merit of this revamped MIE-McKeown operation is well preserving the integrity of azygos arch of vagus nerve and bronchial artery, and it is technically safe and feasible. No postoperative mechanical obstruction of thoracostomach, huge thoracostomach and gastrointestinal dysfunction occurs. [ABSTRACT FROM AUTHOR]

Background: Gastro-cutaneous fistula is a rare complication after laparoscopic sleeve gastrectomy (LSG) with incidence of occurrence 1–2%. Most of gastro-cutaneous fistulae do not respond to conservative management and need intervention either surgically or endoscopically. Methods: This prospective randomized clinical study included referred patients who had LSG performed at our department or other centers, and complicated with post-LSG leak or gastro-cutaneous fistula between December/2019 and March/2021. Included patients were ASA Physical status I–II. Primary and secondary outcomes were recurrence of the fistula and mortality in each group after the intervention during the 18 months follow-up period, respectively. Results: Thirty patients were randomized into two groups: Surgery Group (SG, n = 15) and Endoscopy Group (EG, n = 15). Mean age of patients was 42.3 ± 8.7 and 42.6 ± 8.3 years-old in SG and EG, respectively. Females constituted 73.3% and 80% in SG and EG, respectively. Median time-to-gastric leak post LSG was six (range: 4–7) days in both groups. SG patients were surgically managed with primary repair of the gastric fistula and gastrojejunostomy in 13 patients or converting SG into Roux-en-Y gastric bypass in two patients, while EG patients were endoscopically managed with stitching, stenting, stenting and dilation, and clipping and dilation in 5, 4, 4 and 2 patients, respectively. Incidence of recurrent leak during 1st week was significantly higher in SG than EG (p < 0.001). No mortality reported in EG, while 2 patients died in SG (p = 0.48). Conclusion: Endoscopic intervention may offer a successful modality in managing post-LSG gastric leak and gastro-cutaneous fistula that do not respond to conservative measures in stable patients. [ABSTRACT FROM AUTHOR]

Keywords: Sleeve gastrectomy; Gastro pleural fistula; Fistula; Laparoscopic surgery EN Sleeve gastrectomy Gastro pleural fistula Fistula Laparoscopic surgery 2951 2953 3 08/21/23 20230901 NES 230901 Key points 1. Conclusion In patients with fistula after LSG, if the fistula tract becomes surgically available and has enough space for resecting a piece of the sleeved stomach, resection of the leak point and converting to RYGB can be considered. Management of gastrobronchial fistula after laparoscopic sleeve gastrectomy: Elsevier [Internet]. https://www.sciencedirect.com/science/article/pii/S1550728913002931, [cited 2023 May 20] 6 Sakran N, Zakeri R, Madhok B. Gastric fistula in the chest after sleeve gastrectomy: a systematic review of diagnostic and treatment options. [Extracted from the article]

Introduction Fistulas are abnormal communication between two epithelialized surfaces. Gastrointestinal fistulas are communication between the gut and another epithelialized surface. Fistulas are classified according to anatomic (internal or external), physiologic (output volume), and etiologic characteristics. In the case of clinical suspicion of a fistula, a multidisciplinary approach helps in diagnosing and management. Multidetector computed tomography (MDCT) has an advantage over other imaging modalities due to its ability to reconstruct high-resolution images in seconds, which limits motion or peristalsis artifacts, and is ideal for patients who are uncooperative or who are seriously ill. Aim Evaluation of MDCT as an initial tool in the diagnosis and characterization of gastrointestinal fistulas. Methods During this prospective observational study, MDCT was used to assess patients with clinical suspicion of gastrointestinal fistulas. When necessary, contrast agents were used to identify the enteric fistulous tract. The etiology and characterization of the fistulas were determined. Further, the gastrointestinal fistulas were confirmed via endoscopy, cystoscopy, or surgery. Results The most common type of gastrointestinal fistula is enterocutaneous fistula (ECF) (39%) and the most common cause of gastrointestinal fistulas is postoperative (47%). ECFs were classified according to their etiology, anatomy, and favorable characteristics (85% favorable) along with complexity (64% complex) to aid in the management process. In addition to pancreaticopleural fistulas (22%), biliary (11%), esophageal (8%), and pelvic fistulas (19%) were also observed. There were 19% of fistulas (esophageal and biliary) that were asymptomatic. Endoscopy confirmed such asymptomatic fistulas that were not convincingly detected on CT. Conclusion In this study, we concluded that with the appropriate clinical history, MDCT can accurately depict enteric fistulas. In addition to characterizing fistulas, MDCT is equally useful for detecting secondary complications like inflammation, obstruction, or abscesses. [ABSTRACT FROM AUTHOR]

Purpose: Sleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip. Materials and Methods: Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution. Results: Patients had a mean age of 44 years and mean BMI of 37 kg/m2 ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases. Conclusion: The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG. [ABSTRACT FROM AUTHOR]

Background: Children with severe motor and intellectual disabilities (SMIDs) frequently and continuously receive enteral nutrition and medications and lack adequate exercise, which may lead to dysbiosis, an imbalance in the composition of the gut microbiota. However, studies on the composition of gut microbiota in children with SMIDs are limited. Therefore, we aimed to examine the characteristics of the gut microbiota in children with SMIDs. Methods: 16S rRNA gene sequencing was performed using fecal samples of 10 children with SMIDs, who received enteral nutrition through a gastric fistula or gastric tube (SMID group: median age, 10.0 years), and 19 healthy children (healthy control [HC] group: median age, 9.0 years). Microbial diversity, microbial composition, and abundance of butyric acid‐producing bacteria were compared between the groups. Daily dietary fiber intake in the SMID group was evaluated using questionnaires. Results: The Shannon and Simpson indices (alpha diversity indices) were significantly lower in the SMID group than those in the HC group. Beta diversity analysis identified different clusters. Compared with the HC group, Clostridiales and butyric acid‐producing bacteria were less abundant and Bacteroidales were more abundant in the SMID group. Dietary fiber intake in the SMID group was approximately two‐thirds of the estimated average requirement for healthy Japanese children. Conclusion: Children with SMIDs showed dysbiosis with alteration in the microbial diversity, which could partly be attributed to their low dietary fiber intake. Further studies, with the intervention of prebiotics, probiotics, and synbiotics, are warranted to improve dysbiosis in children with SMIDs. [ABSTRACT FROM AUTHOR]

Background: Gastrobronchial fistulas mostly occur as a result of postoperative complications, including those of bariatric, esophageal, and spleno-pancreatic surgery. Other causes are pneumonia, neoplasm, gastric ulcer, and subphrenic abscess. Traumatic fistulous communications between the stomach and the lung tissue are rare, with only 8 cases reported in the English-language literature (PubMed search) until now. Case Report: We report a 49-year-old female patient with a gastrobronchial fistula secondary to diaphragm rupture 7 years prior, with intrathoracic herniation of the gastric fundus. She underwent thoracotomy for surgical repair. She presented in our Emergency Department with recurrent hemoptysis and painful cough. The diagnosis of the gastrobronchial fistula was confirmed by computed tomography and simultaneous bronchoscopy and esophagogastroscopy, with injection of toluidine blue. As a multidisciplinary team, we opted for surgical repair owing to the fistula extent and severity and the need of repair of the diaphragm hernia. The patient underwent leftsided thoracoscopy. However, owing to dense adhesions and chronic inflammation, we converted to an open procedure. The herniated gastric fundus was repaired by wedge resection. The affected lung tissue was debrided and reconstructed by suture repair. The diaphragmatic defect was closed by sutures with mesh augmentation. The patient's postoperative course was uncomplicated, and she was discharged in good clinical condition on postoperative day 7. Conclusions: Owing to the scarcity of the disease, the management of a gastrobronchial fistula is not standardized. The establishment of the diagnosis of the disease is often challenging. Therapeutic options include conservative measures, endoscopic options, and surgical repair. Our case showed that a multidisciplinary workup is essential for successful treatment. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy (LSG) is a commonly used procedure in bariatric patients that often has excellent results. Despite its advantages, LSG is burdened by specific intraoperative and postoperative early and late complications. One of the life-threatening complications is gastric fistula, usually treated with a multidisciplinary surgical–endoscopic approach. In case of failure of the latter, alternative nonoperative techniques such as the use of autologous stem cells truly represents an innovative possibility, with only few cases described in literature. Here, we report the case of a 25-year-old man with post-LSG broncho-gastric fistula treated with application of autologous stem cells after the failure of the conventional surgical/endoscopic approach. [ABSTRACT FROM AUTHOR]

Background: Endoscopy is the gold standard for the treatment of postoperative gastric leaks (GL). Large fistulas are associated with high rate of treatment failure. The objective of this study was to assess the clinical efficacy of a combining technique using a covered stent (CS) crossing through pigtails (PDs) for large postsurgical GL leaks. Methods: All consecutive patients with large (> 10 mm) postsurgical GL treated endoscopically with a combination of a CS and PDs were included in a single-center retrospective study. The primary endpoint was the rate of GL closure. Results: A total of 29 patients were included. Twenty-five patients underwent sleeve gastrectomy. The fistula (median diameter 15 mm) was diagnosed 6 days (IQR 4–9) after surgery. Technical success was observed in all procedures. After a median follow-up of 10.7 months (IQR 3.8–20.7), GL closure was observed in 82.7% with a median time of 63 days (IQR 40–90). Surgical management was finally necessary in four patients after a median of 186 days (IQR 122–250). No complications related to combined endoscopic treatment were observed especially stent migration during the follow-up. Conclusion: An endoscopic strategy combining CS crossing through PDs appears to be effective, safe and well tolerated for the treatment of large GL. [ABSTRACT FROM AUTHOR]

This article discusses the EDGE procedure, which allows for ERCP following gastric bypass surgeries. One complication of the EDGE ERCP procedure is the development of gastrogastric fistulas. The study presents a case where a patient with a gastrogastric fistula was successfully treated through robotic-assisted laparoscopic resection. The procedure involved mobilizing the excluded stomach, isolating the fistula, and resecting it using an endo GIA stapler. The patient's pain resolved after the surgery, and the weight remained stable. The study concludes that robotic-assisted laparoscopic resection is a safe and effective treatment for gastrogastric fistulas that can occur after EDGE ERCP procedures. [Extracted from the article]

Gastrocolic fistula (GCF) following Roux-en-Y gastric bypass (RYGB) is uncommon. Usually it presents late with nonspecific symptoms and originates from the gastrojejunostomy (GJ). Management of such complication can be surgical, but endoscopic management can be implemented in selected patients. To our knowledge this is the first case reporting an early GCF originating from gastric pouch successfully managed with endoscopic stenting. A 54-year-old female, with surgical history of open vertical band gastroplasty (VBG), complaining of weight regain and reflux symptoms. The plan was to laparoscopically convert VBG to RYGB. Two weeks after, she presented unusually with only fatigue and epigastric pain. Leak was suspected and needed to be ruled out. The patient was presenting in an unusual presentation, i.e. vitally stable and only fatigued. Workup including laboratories, computed tomography, and endoscopy confirmed staple line disruption with development of early GCF. Management included endoscopic fully covered stent, total preantral nutrition. With a well-trained team and the availability of expertise, GCF can be managed with endoscopic stents. • Gastrocolic fistula after Roux-en-Y gastric bypass in the context of bariatric surgery is fairly rare. • Fistula forming at gastrojejunostomy are the most common, presenting as a late complication, with nonspecific symptoms. • Our case is unique in its location, time interval, and how it was successfully managed non surgically. [ABSTRACT FROM AUTHOR]

Background: Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula.Materials and Methods: 82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His.Results: In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients' group.Conclusion: Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion. Trial registration Retrospectively registrated. [ABSTRACT FROM AUTHOR]

Background: Postoperative fistula is a life-threatening complication that lacks a standard treatment strategy after laparoscopic sleeve gastrectomy (LSG). This observational study is the first to report the efficacy and safety of endoscopic full-thickness resection (EFTR) combined with purse-string sutures in treating this complication.Patients and Methods: The old fistula was resected by EFTR, cut radially, and then sutured with a purse-string. The primary endpoint was complete fistula closure within two months. Endoscopic procedure-related complications were also recorded.Results: Eight of 788 LSG patients developed fistulas with an incidence of 1.01%, primarily under the gastroesophageal junction, and the average distance from the center of the fistula to the cardia was 30 ± 6.3 mm. Two patients were cured by conservative treatment, and six received endoscopic sutures. The time from LSG to fistula diagnosis was 12.3 ± 14.4 days. The time from fistula diagnosis to endoscopic repair was 43.8 ± 55.8 days and 21.4 ± 10.0 days after eliminating the data of first case. The average fistula size was 12 ± 10 mm, the average endoscopic procedure duration was 40 ± 16 min, and the average number of endoscopic procedures required was 1.6 ± 0.8. Five patients achieved the primary endpoint, and one patient refused a third endoscopic suture after two sutures. The endoscopy success rate was 83.3%. No endoscopic procedure-related complications occurred.Conclusions: EFTR combined with purse-string sutures is an innovative, safe, and effective endoscopic strategy for postoperative fistula after LSG, avoiding reoperation and allowing early oral feeding. [ABSTRACT FROM AUTHOR]

Background: Persistent gastrocutaneous fistulae frequently complicate gastrostomy tube placement. A minimally invasive technique for tract closure employing balloon catheter retraction and punch excision of the epithelized tract (PEET) was recently reported. We hypothesized the PEET technique of closure would lead to decreased complications without an increased incidence of recurrence.Methods: We conducted a single-center retrospective cohort study evaluating children who underwent gastrocutaneous fistula (GCF) closure 1/1/2018-12/31/2021, comparing patients who underwent the PEET procedure to those repaired with layered closure. Procedure duration and outcomes were additionally compared to the 2018-2019 National Surgical Quality Improvement Program (NSQIP) Participant Use File (PUF) database.Results: Sixty-two children underwent operative GCF closure, including 25 with PEET and 37 traditional layered closure. Procedural time was significantly decreased employing PEET (14 vs 26 minutes, P < .0001), less than half the national median by the NSQIP PUF database of 292 GCF closures (14 vs 34.5 minutes, P < .0001). Those repaired with the PEET method experienced no episodes of recurrence, surgical site infection, readmission, reoperation, or mortality within 30 days of the procedure. Conversely, in traditional closure, there was a 24.3% complication rate, including 7 surgical site infections, 1 readmission, and 2 unplanned reoperations. National procedural complication rate by NSQIP PUF was 5.5%, with a 4.8% rate of surgical site infection, .3% reoperation incidence, and .3% mortality.Discussion: Our study suggests GCF closure employing the PEET procedure is a safe, more efficient method of tract closure than the traditional layered closure technique. [ABSTRACT FROM AUTHOR]