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Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review
Diogo Turiani Hourneaux De Moura, Alberto Baptista, Pichamol Jirapinyo, Eduardo Guimarães Hourneaux De Moura, Christopher Thompson
Clin Endosc 2020;53(1):37-48.   Published online July 9, 2019
DOI: https://doi.org/10.5946/ce.2019.030
AbstractAbstract PDFPubReaderePub
Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopic approaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported.
We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. The primary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management.
A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved in all cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was 22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the success of closure and adverse events in relation to several variables among the subgroups.
The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived from this sparse literature suggest that it can be an option in the management of GI fistulas.

Citations

Citations to this article as recorded by  
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Two Cases of Alimentary Tract Fistula Treated by Endoscopic Local Injection Therapy
Hyun Gun Kim, M.D., Jin Woong Cho, M.D.*, Soo Jin Park, M.D., Tae Hoon Lee, M.D., In Seop Jung, M.D., Bong Min Koh, M.D., Su Jin Hong, M.D., Chang Beom Ryu, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup S
Korean J Gastrointest Endosc 2003;26(6):426-430.   Published online June 30, 2003
AbstractAbstract PDF
Gastrointestinal fistula is a disease of varying etiologies. It may occur spontaneously or as a result of an iatrogenic cause. Spontaneous fistula occurs as a result of an inflammatory process, malignancy or radiotherapy. The majority of fistula are caused by iatrogenic causes, most frequently as a complication of surgical intervention. Treatment of gastrointestinal fistulae usually consists of surgery and conservative management such as nutritional support and control of inflammation. Recently, it has been reported that gastrointestinal fistulae can be treated endoscopically using tissue adhesive agents such as Histoacryl and fibrin glue. We report two cases of gastrointestinal fistulae that were successfully treated by endoscopic local injection therapy with a review of literature. (Korean J Gastrointest Endosc 2003;26:426-430)
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