SSAT - EXTRACELLULAR MATRIX ABSORBABLE PLUGS FOR THE MANAGEMENT OF ENTEROCUTANEOUS FISTULAS: A COMPREHENSIVE REVIEW

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EXTRACELLULAR MATRIX ABSORBABLE PLUGS FOR THE MANAGEMENT OF ENTEROCUTANEOUS FISTULAS: A COMPREHENSIVE REVIEW
Abubaker O. Abdalla^*¹, Azizullah Beran², Payten Schneberger¹, Ali Abdalla³, Stuart K. Amateau¹
¹University of Minnesota Twin Cities, Minneapolis, MN; ²Indiana University, Bloomington, IN; ³University of Khartoum, Khartoum, Khartoum, Sudan

Background
Enterocutaneous fistulas (ECFs) are serious and difficult-to-treat conditions affecting the gastrointestinal (GI) tract. Various etiologies, including surgery, inflammatory conditions, infection, and radiation therapy, can cause them. ECFs have significant morbidities and a negative impact on quality of life. Extracellular matrix (ECM) absorbable plugs have been widely used to treat colo-cutaneous and anorectal fistulas. With the modern advances in the therapeutic endoscopy field, the use of such devices for the management of upper GI and enterocutaneous fistulas has been proposed using various techniques. We conducted a comprehensive review of the efficacy and safety of such devices.

Methods/results
A comprehensive review of MEDLINE and SCOPUS databases looking at the use of ECM plugs for the management of ECF. Five studies (four case series and one retrospective cohort) with a total of 41 patients were included. Surgery was the most common cause of ECF, reported in 58.5% of patients (24/41). Of these, 58.5% were male, with a mean age of 54.6 � 11.6 years. The technical success rate was 75.6% (31/41). The recurrence rate was 29.3% (12/41), requiring additional ECM or other treatment modalities. Complications were reported in only one study, with an incidence of 30.7% and an overall complication rate of 9.7%. Four of the included studies had success rates between 80-100%. The only study with a low success rate of 38.4%, had high-flow fistulas (>500 ml/day) in more than 50% of patients (8/13).

Conclusion
Despite the modern advances in therapeutic endoscopy, treating ECFs remains a challenging problem that requires a multidisciplinary approach. ECM plugs and similar devices are viable and reasonable treatment options for patients with ECF. However, additional studies are needed to evaluate the efficacy of such devices and identify factors that may affect the outcomes in patients with ECF.

Table 1: Characteristics of the study included in the review

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