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Gastrocutaneous fistulas after PEG removal in adult cancer patients: frequency and treatment options

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Abstract

Introduction and aims

PEG removal in head and neck cancer patients (HNCPs) is performed after treatment, in case of disease remission and after adequate oral intake is resumed. The PEG tract usually closes spontaneously within 2–3 days. Persistent gastrocutaneous fistula (GCF) is a rare complication after PEG tube removal and is characterized by the persistence of gastric leakage through the fistulous tract for more than 1 month. Our main goal was to access the incidence and the success of a treatment algorithm for GCF in HNCPs.

Methods

Retrospective unicentric study of HNCPs referred for PEG removal between 2014 and 2018. The patients with GCF were selected and their sequential treatment was reviewed.

Results

In 331 patients with PEGs removed, 19 (5.7%) GCFs were documented. Medical therapy (4–8 weeks) was performed with clinical success (definitive closure of the GCF) in 12 (63.2%) patients. The remaining seven patients required endoscopic or surgical treatment. In four, endoscopic treatment had technical and clinical success (in three patients with fulguration of the gastric leak edges with argon plasma coagulation, silver nitrate in the path and external orifice, and closure of the internal orifice with hemoclips and in one with an over-the-scope-clip). Only three patients underwent surgery, one due to clinical failure of sequential endoscopic therapy and two had direct surgery.

Conclusion

GCF occurs rarely after PEG removal in HNCPs. Medical therapy is usually effective and should be maintained for at least 8 weeks. Endoscopic therapy is an effective second-line option with and surgery rarely required.

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Data availability

The authors confirm that the data supporting the findings of the study are available within the article.

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Funding

The authors received no financial support for the research, authorship or publication of this article.

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Authors and Affiliations

  1. Gastroenterology Department – Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

    P. Currais, S. Faias, F. Francisco, L. Sousa, J. Gramacho & A. Dias Pereira

  2. Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal

    P. Currais

Authors
  1. P. Currais
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  2. S. Faias
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  3. F. Francisco
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  4. L. Sousa
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  5. J. Gramacho
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  6. A. Dias Pereira
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Contributions

SF: conception of the study; SF: expert endoscopists; SF, PC, FF: data analysis; PC: statistical analysis and manuscript draft; SF and DP: critical review of the manuscript.

Corresponding author

Correspondence to P. Currais.

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Disclosures

The authors Pedro Currais, Sandra Faias, Fátima Francisco, Liliana Sousa, Joana Gramacho, and António Dias Pereira have no conflicts of interest or financial ties to disclose.

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Currais, P., Faias, S., Francisco, F. et al. Gastrocutaneous fistulas after PEG removal in adult cancer patients: frequency and treatment options. Surg Endosc 35, 2211–2216 (2021). https://doi.org/10.1007/s00464-020-07627-z

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  • DOI: https://doi.org/10.1007/s00464-020-07627-z

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