Korean J Gastrointest Endosc.  2008 Aug;37(2):116-121.

A Case of Successful Closure using Endoscopic Hemostatic Clips with a Detachable Snare and Fibrin Glue Injection for a Gastro-Cutaneous Fistula following Buried Bumper Syndrome

• Kim HJ
• Kim JW
• Lee IY
• Park KW
• Kim HK
• Suk KT
• Kim MY
• Baik SK

Abstract

The buried bumper syndrome is a well-recognized long-term complication of a percutaneous endoscopic gastrostomy (PEG). Most of the buried bumpers are removed by making an external incision over the PEG site under local anesthesia or during a laparotomy. Recently, endoscopic removal is usually attempted. While the removal of the PEG tube is usually followed by spontaneous closure of the gastrostomy tract, a non-healing gastro-cutaneous fistula is difficult to manage. The fistula is generally treated with bowel rest and total parenteral nutritional support, suppression of gastric acid secretion, and occasionally, surgical exploration and wedge excision of the fistula site are performed. However, in debilitated patients, surgical management is accompanied with high morbidity and mortality. Recently, the use of nonsurgical alternative methods, such as endoscopic therapy using tissue adhesives or hemostatic clips, has emerged with recent advances in endoscopic technology. We report a case of successful closure using endoscopic hemostatic clips with a detachable snare and fibrin glue injection for a gastro-cutaneous fistula following buried bumper syndrome.

Keyword

Buried bumper syndrome; Gastro-cutaneous fistula; Fibrin glue; Detachable snare; Hemoclip

MeSH Terms

Anesthesia, Local
Fibrin
Fibrin Tissue Adhesive
Fistula
Gastric Acid
Gastrostomy
Humans
Laparotomy
Nutritional Support
SNARE Proteins
Tissue Adhesives
Fibrin
Fibrin Tissue Adhesive
SNARE Proteins
Tissue Adhesives