Endoscopic closure of a rectovaginal fistula following surgery for endometriosis using the MARCEAU system

Endoscopy · 2023 · vol. 55(S 01) , pp. E1023–E1024 · doi:10.1055/a-2155-3708 · PMID:37657736 · PMC10473883 · W4386352398
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This study reports the first use of the MARCEAU endoscopic closure system to successfully treat a rectovaginal fistula following endometriosis surgery.

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This case report describes endoscopic closure of a rectovaginal fistula in a 31-year-old woman after colonic resection for endometriosis, using an ESD-assisted technique with the MARCEAU device. Sigmoidoscopy identified the rectal fistula orifice, surrounding mucosa was ablated by ESD to facilitate closure, and the MARCEAU device—an anti-return suture loop fixed and tightened with clips—was used to close the fistula; MRI at 3 months confirmed closure. The authors note that endoscopic closure strategies can be challenging and that technical success in their referenced experience for naïve fistulas did not exceed 70%, but this report’s evidence is limited to a single case without comparative outcomes. This paper is centrally about endometriosis — it reports a rectovaginal fistula occurring after surgery for endometriosis and its endoscopic closure using the MARCEAU system.

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Abstract

A rectovaginal fistula is a rare condition and a therapeutic challenge [1]. Endoscopic closure requires combined approaches with both mucosal ablation and mechanical closure of the fistula [2]. As reported in a recent multicenter study, the novel "fistula endoscopic submucosal dissection with clip closure" (FESDC) strategy is safe and feasible for endoscopic closure of gastrointestinal fistulas [3]; however, in our population, the technical success does not exceed 70 % in naïve fistulas. We previously reported the optimal results of a new closure device called the "mucosal adaptative ring to close endoscopic artificial ulcer" (MARCEAU) in endoscopic leak closure at the ulcer bed after endoscopic submucosal dissection (ESD) and persistent gastrocutaneous fistulas after percutaneous endoscopic gastrotomy [4] [5]. This strategy has not previously been used for gynecological fistulas.
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References

[1] Willingham FF, Buscaglia JM. Endoscopic management of gastrointestinal leaks and fistulae. Clin Gastroenterol Hepatol 2015; 13: 1714 –1721 [2] Bertrand G, Jacques J, Rivory J et al. Deep endoscopic submucosal dissection of a re- fractory tracheoesophageal fistula using clip-and-line traction: a successful closure. Endoscopy 2017; 49: 1278 –1280 [3] Lafeuille P, Wallenhorst T, Lupu A et al. Endoscopic submucosal dissection com- bined with clip closure is effective to close gastrointestinal fistulas including refractory ones. Endoscopy 2022; 54: 700 –705 [4] Masgneaux L, Yzet C, Grimaldi J et al. Endo- scopic closure of the ulcer bed after endo- scopic resection using the “mucosal adap- tive ring to close an endoscopic artificial ulcer ” (MARCEAU) procedure. Endoscopy 2022; 54 (Suppl. 02): E1076 –E1077 [ 5 ] G r a uR ,P i o c h eM ,R i v o r yJe ta l .E n d o s c o p i c closure of a gastric perforation using muco- sal adaptative ring to close endoscopic arti- ficial ulcer: the MARCEAU system. Endos- copy 2023; 55 (Suppl. 01): E297 –E298

Bibliography

Endoscopy 2023; 55: E1023 –E1024 DOI 10.1055/a-2155-3708 ISSN 0013-726X © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permit- ting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Georg Thieme Verlag KG, Rüdigerstraße 14, 70469 Stuttgart, Germany ▶ Fig. 2 Schematic view of the “mucosal adaptive ring to close an endoscopic artificial ulcer ” (MARCEAU) device showing: a fixation of the device at the edge of the ulcer; b clipping along the ulcer; c closure of the ulcer by tightening the device with a forceps. ENDOSCOPY E-VIDEOS https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https:// www.research4life.org/access/eligibility/). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos E1024 De Cristofaro Elena et al. Endoscopic closure of … Endoscopy 2023; 55: E1023 –E1024 | © 2023. The Author(s). E-Videos

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endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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