ASGE Endo Hangout: Approach to Fistulas/Leaks/Perforations

Video Transcription

Video Summary

In this ASGE Endo Hangout session for GI Fellows, experts in therapeutic endoscopy explore management strategies for fistulas, leaks, and perforations. Facilitated by Michael DeLutri and moderated by Michelle Bayliss, the webinar presents case studies and discusses various endoscopic techniques and tools.<br /><br />Case one focuses on a chronic PEG tube-related gastrocutaneous fistula. Dr. Ahmad Bazerbashi and Dr. Alison Schulman highlight the importance of de-epithelialization using APC or a cytology brush and the selection of appropriate over-the-scope (OTS) clips or suturing techniques. Despite prior unsuccessful use of an OTS clip, the experts discuss re-strategizing with different closure techniques.<br /><br />Case two involves a post-sleeve gastrectomy leak. Initial management with internal drainage and pigtail stents is discussed, with subsequent dilatation and stenting to manage a distal stricture. Dr. Schulman emphasizes the importance of addressing any distal strictures to facilitate leak closure and outlines different endoscopic approaches depending on whether the leaks are acute or chronic.<br /><br />The third case presented by Dr. Ahmad Bazerbashi features endoscopic vacuum (VAC) therapy for an esophageal defect following ablation. VAC therapy's application, effectiveness, and procedural complexities such as sponge sizing and insertion are discussed.<br /><br />Throughout the session, procedural tips, complications, and equipment details are shared, including the use of methylene blue, guiding wires, different OTS clip brands, and the applicability of pneumatic dilation. The panelists encourage a multidisciplinary approach for optimal management and underscore the necessity of repeated procedures and careful patient follow-up.<br /><br />The session concludes with a Q&A segment addressing further intricacies of leak management and the feasibility of cutaneous closure techniques, solidifying the comprehensive understanding of advanced endoscopic interventions.

Keywords

therapeutic endoscopy

fistulas

leaks

perforations

PEG tube

gastrocutaneous fistula

over-the-scope clips

post-sleeve gastrectomy

endoscopic vacuum therapy

methylene blue

pneumatic dilation

multidisciplinary approach