Korean Journal of Gastrointestinal Endoscopy 2008;37(2): 116-121.
Buried Bumper 증후군으로 인해 발생한 위-피부 누공에 대하여 내시경적 Fibrin Glue 주입과 박리성 올가미(Detachable Snare)와 금속 클립(Hemoclip) 결찰로 봉합에 성공한 1예
김혜정ㆍ김재우ㆍ이일영ㆍ박경원ㆍ김헌국ㆍ석기태ㆍ김문영ㆍ백순구
연세대학교 원주의과대학 내과학교실
A Case of Successful Closure using Endoscopic Hemostatic Clips with a Detachable Snare and Fibrin Glue Injection for a Gastro-Cutaneous Fistula following Buried Bumper Syndrome
Hye Jeong Kim, M.D., Jae Woo Kim, M.D., Il Young Lee, M.D., Kyong Won Park, M.D., Hearn Kook Kim, M.D., Ki Tae Suk, M.D., Moon Young Kim, M.D. and Soon Koo Baik, M.D.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
Abstract
The buried bumper syndrome is a well-recognized long-term complication of a percutaneous endoscopic gastrostomy (PEG). Most of the buried bumpers are removed by making an external incision over the PEG site under local anesthesia or during a laparotomy. Recently, endoscopic removal is usually attempted. While the removal of the PEG tube is usually followed by spontaneous closure of the gastrostomy tract, a non-healing gastro- cutaneous fistula is difficult to manage. The fistula is generally treated with bowel rest and total parenteral nutritional support, suppression of gastric acid secretion, and occasionally, surgical exploration and wedge excision of the fistula site are performed. However, in debilitated patients, surgical management is accompanied with high morbidity and mortality. Recently, the use of nonsurgical alternative methods, such as endoscopic therapy using tissue adhesives or hemostatic clips, has emerged with recent advances in endoscopic technology. We report a case of successful closure using endoscopic hemostatic clips with a detachable snare and fibrin glue injection for a gastro-cutaneous fistula following buried bumper syndrome. (Korean J Gastrointest Endosc 2008;37:116-121)
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