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KMID : 0359020080370020116
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Korean Journal of Gastrointestinal Endoscopy
2008 Volume.37 No. 2 p.116 ~ p.121
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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
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Kim Hye-Jeong
Kim Jae-Woo
Lee Il-Young
Park Kyong-Won
Kim Hearn-Kook
Suk Ki-Tae
Kim Moon-Young
Baik Soon-Koo
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Abstract
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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 gastrocutaneous 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.
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KEYWORD
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Buried bumper syndrome, Gastro-cutaneous fistula, Fibrin glue, Detachable snare, Hemoclip
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