Post written by iGIE iNTERNATIONAL Associate Editor Diogo Turiani Hourneaux de Moura, MD, MSc, PhD, Post-PhD, from the Gastrointestinal Endoscopy Division, Hospital Vila Nova Star, Instituto D’Or de Pesquisa e Ensino, and the Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

The goal of this study was to demonstrate that autologous abdominal fat transplantation has the potential to become an alternative therapy for GI fistulas.

It was important to conduct this study to show the novel use of autologous abdominal fat transplantation for the treatment of a chronic pyriform sinus-cutaneous fistula.

Pyriform sinus-cutaneous fistulas are often observed in pediatric patients but are very rare in adults. Diagnosing this condition in adults is challenging, and contrast-enhanced CT misdiagnosis is not uncommon. Neck abscess formation secondary to this fistula is treated with surgical incision and drainage, but recurrence can occur because of the fistula.

Although surgery is the most effective treatment modality, less-invasive therapies such as electrocauterization or chemocauterization may be indicated. However, treatment with these cauterization techniques has a high treatment failure rate.

To our knowledge, this is the first case report of diagnosing by EGD a pyriform sinus fistula in an adult treated with autologous abdominal fat transplantation associated with adjunctive conventional endoscopic therapies.

This is a case of a young woman with a history of 2 cervical abscesses who was admitted because of a recurrent abscess with unknown etiology. She underwent surgical drainage with intraoperative EGD under fluoroscopic assistance, and a pyriform sinus-cutaneous fistula was diagnosed.

Successful treatment was achieved using autologous adipose abdominal tissue collected by lipoaspiration associated with argon plasma coagulation and endoscopic vacuum therapy. Immediately after the procedure, the patient no longer experienced fluid discharge through the skin. The patient had no recurrence within 10 months of follow-up.

Based on this report, we believe that autologous abdominal fat transplantation may be an effective minimally invasive therapy for pyriform sinus-cutaneous fistulas and has the potential to become an alternative therapy for GI fistulas. We encourage future studies to exploit the role of this therapy for GI fistulas.

Unprocessed autologous adipose abdominal tissue collected by lipoaspiration. A, Unprocessed adipose abdominal tissue immediately after acquisition by lipoaspiration. B, Unprocessed adipose tissue introduced in a 20 mL syringe. C, Adipose tissue transfer to a 3 mL syringe. D, Unprocessed autologous adipose abdominal tissue in a 3 mL syringe ready for use.

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