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Endoscopic fistulotomy in inflammatory bowel disease (with video)

  • Gursimran Kochhar
    Affiliations
    The Interventional IBD Unit, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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  • Bo Shen
    Correspondence
    Reprint requests: Bo Shen, MD, FASGE, The Interventional IBD (i-IBD) Unit, Digestive Disease and Surgery Institute-A31, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.
    Affiliations
    The Interventional IBD Unit, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for articles by this author
Published:February 28, 2018DOI:https://doi.org/10.1016/j.gie.2018.02.034

      Background and Aims

      Fistulas in patients with inflammatory bowel disease (IBD) pose a key challenge in the management of these patients. We aimed to describe a novel endoscopic method to treat patients with IBD who have fistulas.

      Methods

      A cohort of 29 consecutive patients with fistulas and IBD were identified in the registry of our interventional IBD unit. An endoscopic fistulotomy with needle-knife was performed. The primary outcome was healing of the fistula without the need for surgical intervention.

      Results

      A total of 29 patients underwent endoscopic fistulotomy; and the mean (± standard deviation) age of patients undergoing the procedure was 44.2 ± 14.6 years. Thirteen patients were male (44.8%), and 16 were female (55.2%). Twenty-six patients (89.6%) achieved complete resolution of the fistula as confirmed by endoscopy with a guidewire and/or cross-sectional abdominal imaging, with 10 patients (34.4%) requiring a single endoscopic treatment session. Three patients (10.3%) had a persistent fistula and required surgical intervention. One patient had postoperative bleeding requiring blood transfusion and hospitalization.

      Conclusion

      Endoscopic fistulotomy with a needle-knife appears to be safe and effective in treating IBD-related fistulas.

      Graphical abstract

      Abbreviations:

      CD (Crohn’s disease), IBD (inflammatory bowel disease), i-IBD (interventional IBD center), IPAA (ileal pouch anal anastomosis), OTSC (over-the scope clip), SD (standard deviation)
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      References

        • Fazio V.W.
        • Kiran R.P.
        • Remzi F.H.
        • et al.
        Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients.
        Ann Surg. 2013; 257: 679-685
        • Chen M.
        • Shen B.
        Endoscopic therapy in Crohn’s disease: principle, preparation, and technique.
        Inflamm Bowel Dis. 2015; 21: 2222-2240
        • Tekkis P.P.
        • Fazio V.W.
        • Remzi F.
        • et al.
        Risk factors associated with ileal pouch-related fistula following restorative proctocolectomy.
        Br J Surg. 2005; 92: 1270-1276
        • Nisar P.J.
        • Kiran R.P.
        • Shen B.
        • et al.
        Factors associated with ileoanal pouch failure in patients developing early or late pouch-related fistula.
        Dis Col Rectum. 2011; 54: 446-453
        • Sands B.E.
        • Anderson F.H.
        • Bernstein C.N.
        • et al.
        Infliximab maintenance therapy for fistulizing Crohn’s disease.
        N Engl J Med. 2004; 350: 876-885
        • Chidi V.
        • Shen B.
        Endoscopic needle knife fistulotomy technique for ileal pouch-to-pouch fistula.
        Endoscopy. 2015; 47: E261
        • Shen B.
        Exploring endoscopic therapy for Crohn’s disease-related fistula and abscess.
        Gastrointest Endosc. 2017; 85: 1133-1143
        • Sagar P.M.
        • Pemberton J.H.
        Intraoperative, postoperative and reoperative problems with ileoanal pouches.
        Br J Surg. 2012; 99: 454-468
        • Vitton V.
        • Gasmi M.
        • Barthet M.
        • et al.
        Long-term healing of Crohn’s anal fistulas with fibrin glue injection.
        Aliment Pharmacol Ther. 2005; 21: 1453-1457
        • Haito-Chavez Y.
        • Law J.K.
        • Kratt T.
        • et al.
        International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video).
        Gastrointest Endosc. 2014; 80: 610-622
        • Sinh P.
        • Shen B.
        Endoscopically placed guidewire-assisted seton for an ileal pouch-pouch fistula.
        Gastrointest Endosc. 2015; 82: 575-576
        • Panés J.
        • García-Olmo D.
        • Van Assche G.
        • et al.
        Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised, double-blind controlled trial.
        Lancet. 2016; 388: 1281-1290