AbstractEnterocutaneous fistulae (ECFs), abnormal epithelialized connections between the small bowel and skin, are associated with significant morbidity, and pose a unique challenge to patients and clinicians. Management of ECF requires sepsis control, effluent management, nutritional support, and local wound care. Traditionally, surgical intervention was required for ECF that failed to close with conservative management. With the rise of therapeutic endoscopy, new management strategies have emerged. Fluoroscopy-guided endoscopy is now used to delineate anatomy and determine potential therapy options. Definitive endoscopic management may involve through-the-scope and over-the-scope clips, or endoscopic suturing devices. Adjuncts to definitive management include removing foreign bodies, alleviating distal obstructions, and de-epithelializing fistula tracts. Even if an ECF is not amenable to definitive endoscopic therapy, endoscopy may help temporize and optimize a patient preoperatively. Endoscopy allows for the placement and repositioning of drains, stent placement to allow for diversion or improved wound care, and the placement of enteric feeding access. As endoscopic techniques expand and more tools become available, the ability to manage complex problems, such as ECF, endoscopically will grow.
The Use and Safety of POEM and Other Definitive Management Strategies for Achalasia
