Buscar en
Gastroenterología y Hepatología
Toda la web
Inicio Gastroenterología y Hepatología External digital pressure to enable a deeper tulip-bundle technique for endoscop...
Información de la revista
Vol. 40. Núm. 4.
Páginas 290-291 (Abril 2017)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 40. Núm. 4.
Páginas 290-291 (Abril 2017)
Scientific letter
DOI: 10.1016/j.gastrohep.2016.02.001
Acceso a texto completo
External digital pressure to enable a deeper tulip-bundle technique for endoscopic closure of a refractory chronic gastrocutaneous fistula
Presión digital externa para permitir una técnica de «tulip-bundle» más profunda para el cierre endoscópico de una fístula gastrocutánea crónica refractaria
Visitas
...
Ana Ponte
Autor para correspondencia
ana.ilponte@gmail.com

Corresponding author.
, Rolando Pinho, Teresa Pinto-Pais, Adélia Rodrigues, Iolanda Ribeiro, Luísa Proença, Joana Silva, Jaime Rodrigues, João Carvalho
Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (4)
Mostrar másMostrar menos
Material adicional (1)
Texto completo
Dear Editor,

The authors present a case of a 68-year-old woman with end-stage metastatic breast cancer and biphosphonate-related osteonecrosis of the jaw with a chronic gastrocutaneous fistula which persisted a month after removal of a 24 Fr percutaneous endoscopic gastrostomy (PEG) tube. Conservative management with intravenous antibiotics, regular wound cleaning, high-dose proton pump inhibitor and a nasojejunal tube for enteral feeding was instituted. After two unsuccessful attempts to close the gastric defect with endoclips, a third endoscopy was performed revealing extravasion of methylene blue through the gastric orifice with the previously placed endoclips (Fig. 1). After closure of the gastric orifice with additional endoclips, a tulip-bundle technique was performed. In this technique an endoloop snare (MAJ-254; Olympus, Japan) was placed over the endoclips resulting in closure of fistulous tract (Video). External digital pressure of the stoma enabled proper positioning of the endoloop deeper below the endoclips, which was then tightened around the endoclips (Fig. 2) closing the gastric orifice (Fig. 3). A follow-up endoscopy performed half a month later revealed complete closure of the gastric defect with no extravasion of methylene blue (Fig. 4A) to the skin (Fig. 4B).

Figure 1.

Endoscopic image revealing the gastric orifice partially closed with endoclips.

(0,14MB).
Figure 2.

Endoscopic image showing proper placement and tightening of the endoloop around the endoclips.

(0,15MB).
Figure 3.

Endoscopic image showing complete closure of the gastric orifice, after releasing the endoloop.

(0,17MB).
Figure 4.

(A) Endoscopic image showing methylene blue instillation over the previous gastric defect. (B) No extravasion of methylene blue through the cutaneous orifice occurred.

(0,26MB).

Although PEG is a safe and efficient procedure for enteral nutrition, some complications may occur, including peristomal infection, leakage and chronic gastrocutaneous fistula.1–3

The tulip-bundle technique has a range of applications including hemostasis and closure of perforations and fistulae.3–6 The tulip-bundle technique may represent a good alternative for closure of chronic gastrocutaneous fistula,3 which is particularly useful in patients with multiple comorbidities as our patient.

Appendix A
Supplementary data

The following are the supplementary data to this article:

(10,59MB)

References
[1]
A. Ponte, R. Pinho, J. Carvalho.
Thinking outside the box of the gastrostomy kit: stylet-assisted technique for challenging gastrostomy tube replacements.
Clin Gastroenterol Hepatol, 13 (2015), pp. e137-e138
[2]
D. Westaby, A. Young, P. O’Toole, G. Smith, D.S. Sanders.
The provision of a percutaneously placed enteral tube feeding service.
Gut, 59 (2010), pp. 1592-1605
[3]
F. Perri, M. Gentile, D. Scimeca, F. Terracciano, A. Merla, F. Spirito, et al.
Closure of a gastrocutaneous fistula by a tulip-bundle technique.
Endoscopy, 43 (2011), pp. E419
[4]
R. Pinho, J. Silva, A. Ponte, J. Rodrigues, I. Ribeiro, M.C. Lucas, et al.
Grasp-to-retract modification of the tulip-bundle technique in forward and retroflexed position in the sigmoid colon for difficult hemostasis.
Endoscopy, 47 (2015), pp. E554-E555
[5]
F. Mocciaro, G. Curcio, I. Tarantino, L. Barresi, M. Spada, S.L. Petri, et al.
Tulip bundle technique and fibrin glue injection: unusual treatment of colonic perforation.
World J Gastroenterol, 17 (2011), pp. 1088-1090
[6]
G. Curcio, R. Badas, R. Miraglia, L. Barresi, I. Tarantino, M. Traina.
Duodenal stump fistula following Roux-en-Y gastrectomy, treated with single-balloon enteroscopy using the tulip bundle technique and fibrin glue injection.
Endoscopy, 44 (2012), pp. E364-E365
Copyright © 2016. Elsevier España, S.L.U., AEEH y AEG
Opciones de artículo
Herramientas
Material suplementario
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.