Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study

Background and aim: Endoscopic closure of fistulas is desirable but remains a challenge, especially for gastrogastric fistulas. The aim of this study was to assess the success rate for the closure of gastrointestinal fistulas using an endoscopic suturing device. Patients and methods: Electronic records at three medical centers were reviewed to identify patients who underwent sutured fistula closure as recorded on a central database. Demographic details, clinical variables, and details of the endoscopic procedure were recorded. Results: A total of 56 patients (mean age 54 +/- 12.7 years) underwent fistula closure. Gastrogastric fistulas were most common (n=29; 51.8 %). Sixteen patients (28.6 %) had undergone previous failed attempts at closure. Immediate success was universal (n=56; 100%). Thirteen patients had persistent closure without any need for further therapies, while 17 underwent additional endoscopic procedures, with successful closure in 4/17. Only one patient had abdominal pain requiring hospital admission. Conclusion: Sutured closure of fistulas in a single session is safe and can be expected, even in what are known to be challenging cases. Sequential closure for recurrences is sometimes successful in the longer term.