Clinical Research In The Endoscopic Mangement Of Digestive Fistula

Background:Gastrointestinal fistulae can be serious complication or chronic morbid condition resulting from inflammatory and it is associated with a high rate of mortality(80%).Traditional treatments such as surgery,stent placement and endoscopic suturing are not sufficient to treat the sickness.With the development of endoscopic technology,lots of digestive disease such as bleeding,perforation,tumor can be treated effectively.How to mangement digestive fistuals by endoscopic technologies is a focal point.Objective:To evaluate the efficacy and outcomes of endoscopic treatment for digestive fistula,and choose suitable endoscopic methods for different fistulas.Materials and Methods:From July,2015 to July,2017,totally 38 endoscopic treatments for digestive fistulas were gathered.Choose suitable treatments according to the size and the site of the fistulas.The methods including endoscopic clipping,OTSC and endoscopic jejunal tube placement.Results:Totally 38 fistulas were treated endoscopically.Jejunal tube was placed in 13 fistulas,OTSC in 5 fistulas and endoscopic clipping in 20.All patients were completed the endoscopic operation successfully with no significant complication.OTSC group total efficiency is 100%,the postoperative hospital stay is 5.2±1.7 days.In jejunal tube group,one patient died from function failure of organ failure because of infection.4 fistulas fully healed,3 narrowed,its efficiency is 30.8%,the postoperative hospital stay is 47.4±14.1 days.For endoscopic clipping group,one patients died from septic shock.In the remaining 19,the total efficiency is 80%and the postoperative hospital stay is 17.9±8.9 days.Conclisions:Endoscopic jejunal tube placement as an adjunctive therapy can effective improve the prognosis when combined to other methods.For small(<1cm)and no-anabrotic fistulas,endoscopic clipping can be a suitable method to close the fistula.For big or obviously anabrotic lesions,OTSC may be the best choice.Multimethod combination is advantageous to treating refractory fistula.