Endoscopy pp 50-57 | Cite as

Therapy of Gastrointestinal Fistulas with Fibrin Sealant

  • M. Jung
  • B. C. Manegold
Conference paper
Part of the Fibrin Sealing in Surgical and Nonsurgical Fields book series (ADMERE, volume 8)

Abstract

Gastrointestinal and respiratory fistulas are commonly associated with a prolonged and complicated clinical course. The technique of endoscopic fistula treatment using fibrin tissue adhesives was developed during the past decade. Fibrin sealing can be achieved by endoscopic application of a two-component system (Tissucol) which promotes the normal process of wound healing. The substance was first used in babies in closing isolated hair fistulas and esophageal recurrent fistulas after surgical correction of esophageal atresia. From 1974–1990, 14 babies with recurrent fistulas were treated with Tissucol (n = 12) and formerly with Histoacryl (n = 2). Endoscopic closure was successful in 11 out of the 14 babies. In two further children endoscopic therapy was successful in gluing broad submucosal lesions in the colonic wall following bougienage and sealing a small perforation in the esophagus following dilatation of a benign stenosis. Since 1984 indication for sealing gastrointestinal and tracheobronchial fistulas in adults has been extended. Esophageal fistulas seem to be a very suitable field for fibrin sealant application. Critically ill patients with anastomotic leakages in the esophagus, perforation due to radiotherapy, trauma, endoscopic procedure, or inflammatory disease were treated as well as patients with tumor fistulas. Endoscopic closures of fistulas were successful in 19 out of 24 patients in one to four sessions. Fibrin sealing failed in nearly all cases of tumor fistulas and in wide infected leakiness. Ineffective results can be caused by incorrect preparation and application of the substance and by early stressing the fibrin clot within the first 24 h. Nevertheless, the endoscopic procedure is especially of interest in critically ill patients and may be today an attractive alternative to major surgical procedures.

Keywords

Migration Catheter Syringe Immobilization Mane 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • M. Jung
  • B. C. Manegold

There are no affiliations available

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