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Multicenter Study
. 2024 Nov;38(11):6305-6311.
doi: 10.1007/s00464-024-11166-2. Epub 2024 Aug 26.

Over-the-scope clip for closure of persistent gastrocutaneous fistula after gastrostomy tube removal: a multicenter pediatric experience

Antonio Corsello #  1   2 , Matthieu Antoine #  1 , Shishu Sharma  3 , Valérie Bertrand  4 , Salvatore Oliva  5 , Giorgio Fava  6 , Francesca Destro  7 , Andrew Huang  8 , Wei S W Fong  3 , Martina Ichino  6 , Mike Thomson  3 , Frederic Gottrand  9   10
Affiliations
Multicenter Study

Over-the-scope clip for closure of persistent gastrocutaneous fistula after gastrostomy tube removal: a multicenter pediatric experience

Antonio Corsello et al. Surg Endosc. 2024 Nov.

Abstract

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.

Keywords: Closure techniques; Gastrocutaneous fistula; OTSC; Ovesco; PEG removal; Pediatric surgery.

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Conflict of interest statement

Antonio Corsello, Matthieu Antoine, Shishu Sharma, Valérie Bertrand, Salvatore Oliva, Giorgio Fava, Francesca Destro, Andrew Huang, Wei SW Fong, Martina Ichino, Mike Thomson, and Frederic Gottrand have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Most used over-the-scope clip (OTSC) devices and their specifics [36]. The “a clip” with round teeth is used if blunt compression of the tissue is intended. The “t clip” has spikes and is used if additional anchoring of the clip is intended, e.g., in fibrotic tissue. A standard 9–10-mm pediatric gastroscope was typically used for the OTSC procedure, accommodating the deployment of 11-mm or 12-mm clips
Fig. 2
Fig. 2
Persistent gastrocutaneous fistula at the time of the closure with over-the-scope clip (OTSC) (A) and at 8 months later (B), when biopsies of the mucous bud found gastric mucosa
Fig. 3
Fig. 3
Endoscopic aspect of an over-the-scope clip (OTSC) closure (A), 8 months after the procedure (B)
See this image and copyright information in PMC

References

    1. Kvello M, Knatten CK, Bjørnland K (2020) Laparoscopic gastrostomy placement in children has few major, but many minor early complications. Eur J Pediatr Surg 30:548–553. 10.1055/s-0039-3401988 - PubMed
    1. Suksamanapun N, Mauritz FA, Franken J, van der Zee DC, van Herwaarden-Lindeboom MY (2017) Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: results of a systematic review and meta-analysis. J Minim Access Surg 13:81–88. 10.4103/0972-9941.181776 - PMC - PubMed
    1. Homan M, Hauser B, Romano C, Tzivinikos C, Torroni F, Gottrand F, Hojsak I, Dall’Oglio L, Thomson M, Bontems P, Narula P, Furlano R, Oliva S, Amil-Dias J (2021) Percutaneous endoscopic gastrostomy in children: an update to the ESPGHAN position paper. J Pediatr Gastroenterol Nutr 73:415–426. 10.1097/MPG.0000000000003207 - PubMed
    1. Romano C, van Wynckel M, Hulst J, Broekaert I, Bronsky J, Dall’Oglio L, Mis NF, Hojsak I, Orel R, Papadopoulou A, Schaeppi M, Thapar N, Wilschanski M, Sullivan P, Gottrand F (2017) European society for paediatric gastroenterology, hepatology and nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 65:242–264. 10.1097/MPG.0000000000001646 - PubMed
    1. El-Rifai N, Michaud L, Mention K, Guimber D, Caldari D, Turck D, Gottrand F (2004) Persistence of gastrocutaneous fistula after removal of gastrostomy tubes in children: prevalence and associated factors. Endoscopy 36:700–704. 10.1055/s-2004-825662 - PubMed

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