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Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review
Diogo Turiani Hourneaux De Moura,Alberto Baptista,Pichamol Jirapinyo,Eduardo Guimarães Hourneaux De Moura,Christopher Thompson 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.1
Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopicapproaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported. We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. Theprimary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management. A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved inall cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the successof closure and adverse events in relation to several variables among the subgroups. The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived fromthis sparse literature suggest that it can be an option in the management of GI fistulas.