Post written by Shailendra Singh, MD, and Ethan Cohen, MD, from West Virginia University, Morgantown, West Virginia, USA.

This video case series highlights the novel application of cardiac septal occluder (CSO) devices for endoscopic closure of esophageal, gastric, jejunal, and rectal fistulas. Traditionally, managing these complex fistulas and anastomotic leaks has been challenging, often requiring multiple endoscopic attempts or surgical intervention, which are associated with high morbidity.

This video features cases where patients had persistent GI fistulas that failed standard closure techniques, including clips, stents, suturing, and argon plasma coagulation. Each case demonstrates the step-by-step process of CSO deployment, from creating a custom delivery system to achieving complete fistula closure and tissue ingrowth over time.

We felt it was crucial to share this video case series because CSOs represent an innovative solution for refractory GI fistulas, providing a minimally invasive alternative with promising success rates. CSOs can serve as an important addition to the armamentarium of endoscopic closure devices, particularly in cases where conventional techniques have failed, offering a viable strategy for effective management of GI fistulas.

Endoscopists can gain several key insights from this case series:

• The importance of multimodal endoscopic approaches—CSOs can be considered after failure of traditional endoscopic closure techniques, including over-the-scope clips, suturing, and stents.
• Customization of the delivery system and placement—The video shows how to create a CSO deployment system using a modified catheter and biopsy forceps, allowing for endoscopic placement.
• Locations in the GI tract—CSOs successfully closed fistulas in the esophagus, stomach, jejunum, and colon.

This video case series contributes to the growing body of evidence supporting CSO use in endoscopy. Further prospective studies will be essential to establish standardized protocols, assess long-term outcomes, and optimize patient selection criteria.

Close-up visualization of a cardiac septal occluder device. A, Sheath. B, Delivery cable. C, Waist length. D, Device size (waist diameter). E, Disc diameter.

Read the full article online.

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