Endoscopic Closure of Esophageal, Gastric, Jejunal, and Recto-Pelvic Fistulas with Cardiac Septal Occluder Devices: A Case Series

Background and Aims Treating gastrointestinal fistulas and anastomotic leaks is a challenge. Traditionally, these complications have been treated with conservative measures or surgical interventions, both of which have been associated with high rates of morbidity. While endoscopic techniques are available and commonly minimally invasive, their success can be variable and oftentimes require repeat interventions. Cardiac septal occluder (CSO) devices have emerged as an alternative for managing these complex gastrointestinal fistulas and anastomotic leaks after the more conservative endoscopic options fail. Methods Prior to introduction of the CSO device into the body, a CSO delivery system must first be created. After equipping this system to an endoscope, argon plasma coagulation is used on each of the fistulas, and the CSOs are then deployed under fluoroscopy. Cases We present four cases of CSO device placement throughout the gastrointestinal tract -- in the esophagus, jejunum, stomach, and rectosigmoid colon. Each of these cases presents unique challenges in maneuvering the anatomy, ensuring the CSOs fully occlude the fistulas, and are successful in causing tissue in-growth post placement. Conclusions This study presents a case series of four successful closures of gastrointestinal fistulas using CSO devices following the failure of more conservative therapies. Each of these cases takes place in a different part of the gastrointestinal tract – esophagus, stomach, small intestines, and large intestines – indicating the broad application of CSO devices. CSOs offer a promising alternative for managing complex gastrointestinal fistulas and post-surgical anastomotic leaks endoscopically throughout the entire gastrointestinal tract.