Endoscopic fistulotomy in inflammatory bowel disease (with video)

Background and Aims: Fistulas in patients with inflammatory bowel disease (IBD) pose a key challenge in the management of these patients. We aimed to describe a novel endoscopic method to treat patients with IBD who have fistulas. Methods: A cohort of 29 consecutive patients with fistulas and IBD were identified in the registry of our interventional IBD unit. An endoscopic fistulotomy with needle-knife was performed. The primary outcome was healing of the fistula without the need for surgical intervention. Results: A total of 29 patients underwent endoscopic fistulotomy; and the mean (+/- standard deviation) age of patients undergoing the procedure was 44.2 +/- 14.6 years. Thirteen patients were male (44.8%), and 16 were female (55.2%). Twenty-six patients (89.6%) achieved complete resolution of the fistula as confirmed by endoscopy with a guidewire and/or cross-sectional abdominal imaging, with 10 patients (34.4%) requiring a single endoscopic treatment session. Three patients (10.3%) had a persistent fistula and required surgical intervention. One patient had postoperative bleeding requiring blood transfusion and hospitalization. Conclusion: Endoscopic fistulotomy with a needle-knife appears to be safe and effective in treating IBD-related fistulas.