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)


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.


Fibrin Sealant Esophageal Atresia Fibrin Clot Recurrent Fistula Tumor Fistula 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Brands W, Lochbühler H, Raute-Kreinsen U, Joppich I, Schaupp W, Menges HW, Manegold BC (1983) Die Fibrinklebung angeborener Oesophagusmißbildungen. Zentralbl Chir 108: 803–807PubMedGoogle Scholar
  2. 2.
    Cadoni S, Ottonello R, Maxia G, Gemini S, Cocco P (1990) Endoscopic treatment of a duodeno-curaneous fistula with fibrin tissue sealant (Tissucol). Endoscopy 22: 194–195PubMedCrossRefGoogle Scholar
  3. 3.
    Eimiller A, Berg P, Born P, Barine W, Zellmer R, Neuhaus H, Paul F, Homann H (1989) Fibrin sealing of fistulas in Crohn’s disease. In: Waclawiczek HW (ed) Progress in fibrin sealing. Springer, Berlin Heidelberg New York, pp 61–64CrossRefGoogle Scholar
  4. 4.
    Eleftheriadis E, Tzartinoglou E, Kotzampassi K, Aletras H (1990) Early endoscopic fibrin sealing of high-output postoperative enterocutaneous fistulas. Acta Chir Scand 156: 625–628PubMedGoogle Scholar
  5. 5.
    Gdanietz K, Wiesner B, Krause I, Mau H, Jung FJ (1974) Gewebekleber zum Verschluß von Oesophagotrachealfisteln bei Kindern. Z Erkr Atmungsorg 141: 46–50Google Scholar
  6. 6.
    Groitl H, Scheele J (1987) Initial experience with endoscopic application of fibrin tissue adhesive in the upper gastrointestinal tract. Surg Endosc 1: 93–97PubMedCrossRefGoogle Scholar
  7. 7.
    Jung M, Brands W, Manegold BC (1987) Therapeutische Endoskopie mit Fibrinkleber. Med Welt 38: 141–146Google Scholar
  8. 8.
    Jung M, Brands W, Manegold BC (1988) Endoskopische Fisteltherapie mit Fibrinkleber. Schweiz Rundsch Med Prax 77: 3–5PubMedGoogle Scholar
  9. 9.
    Kaeser A, Dum M (1987) Grundlagen der Fibrinklebung-Wirkprinzip- und Infektionssicherheit von Tissucol. Z Herz Thorax Gefäßchir [Suppl] 1: 5–10Google Scholar
  10. 10.
    Kaufner HK (1986) Grundlagen der Fibrinklebung. In: Reifferscheid M (ed) Neue Techniken in der operativen Medizin. Springer, Berlin Heidelberg New York, pp 3–6CrossRefGoogle Scholar
  11. 11.
    Kirkegaard P (1982) Treatment of postoperative fistulae with the fibrin-adhesion system Tisseel. In: Tlsseel/Tissucol-Symposium: areas of application, problems and perspectives in current surgery. Immuno Scientific Workshop, Scanticon, Aarhus, pp 25–29Google Scholar
  12. 12.
    Kohler B, Köhler G, Riemann JF (1988) Spontaneous esophagotracheal fistula resulting from ulcer in heterotopic gastric mucosa. Gastroenterology 95: 828–830PubMedGoogle Scholar
  13. 13.
    Manegold BC, Lochbühler H, Lochbühler H (1988) Endoskopische Verklebung kongenitaler oesophago-trachealer Rezidivfisteln und Fisteln. In: Manegold BC, Jung M (eds) Fibrinklebung in der Endoskopie. Springer, Berlin Heidelberg New York, pp 28–39CrossRefGoogle Scholar
  14. 14.
    Meyer G, Lange H, Wenk H, Schildberg FW (1988) Endoscopic sealing of gastrointestinal fistulae (abstract). Surg Endosc 2: 62Google Scholar
  15. 15.
    Pridun N, Heindl W, Redl H, Schlag G, Machacek E (1986) Animal studies as for the problem of the bronchial fistula. In: Schlag G, Redl H (ed) Thoracic surgery — cardiovascular surgery. Springer, Berlin Heidelberg New York, pp 121–125 (Fibrin sealant in operative medicine, vol 5)Google Scholar
  16. 16.
    Redl H, Schlag G (1986) Fibrin sealant and its modes of application. In: Schlag G, Redl H (eds) Thoracic surgery — cardiovascular surgery. Springer, Berlin Heidelberg New York, pp 121–125 (Fibrin sealant in operative medicine, vol 5)Google Scholar
  17. 17.
    Riemann JF, Ell C (1985) Endoskopischer Verschluß einer tumorbedingten oesophagomediastinalen Fistel mit einer schnellhärtenden Aminosäurelösung. Dtsch MedWochenschr 110: 396PubMedGoogle Scholar
  18. 18.
    Rolfs HC, Bülzebruck A (1988) Kombinierter therapeutischer Einsatz von Fibrinkleber und Tubusimplantation bei ösophagobronchialen Tumorfisteln. In: Manegold BC, Jung M (eds) Fibrinklebung in der Endoskopie. Springer, Berlin Heidelberg New York, pp 66–68CrossRefGoogle Scholar
  19. 19.
    Straumann A, Gyr K, Stalder GA (1984) Tissue adhesive in the prevention of esophageal tube migration: report on a new method. Schweiz Rundschau Med Praxis 73: 1086–1087Google Scholar
  20. 20.
    Waclawiczek HW (1987) Endoskopischer Verschluß infizierter Bronchusstumpf- Fisteln nach Lungenresektion mit der Fibrinklebung (FK) — Klinische und experimentelle Ergebnisse. Z Herz Thorax Gefasschir 1 [Suppl]: 63–66Google Scholar
  21. 21.
    Wenzel M (1985) Fistelverschluß mit Fibrinkleber. Chir Praxis 34: 267–275Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • M. Jung
  • B. C. Manegold

There are no affiliations available

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