The first case series for the use of endoscopic delivery of stromal vascular fraction obtained by mechanical emulsification of autologous adipose tissue (tSVFem) for the treatment of upper gastrointestinal (GI) tract fistulas was published in Gastroenterology.

Upper GI fistulas can be caused by traumatic, iatrogenic, or postoperative injuries, as well as Boerhaave syndrome. Despite the high mortality rate (>50%), no clear guidelines for the treatment of this condition have been elucidated.

Between 2019 and 2020, 5 patients (3/5 female; aged mean 49.6±14.5 years) presented at a hospital in Italy with esophageal fistulas and were unfit for endoscopy and/or surgery. The fistulas presented in the distal (Boerhaave syndrome: n=2; postoperative: n=1) and upper (traumatic: n=1; other: n=1) esophagus. The fistulas had a mean diameter of 8 mm (range, 4-15 mm).


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The tSVFem procedure was performed by a team of endoscopists and thoracic and plastic surgeons a mean of 22 days (range, 10-100 days) after detection. The procedures took an average of 50±20 minutes to complete.

Prior to procedure, ~30 mL of microfat tissue was harvested with a 2.1-mm microcannula with 4, 1-mm holes. Emulsification of 20 mL of the microfat was achieved by passing it through a series of filters in order to obtain mesenchymal stromal cells and extracellular matrix fragments. During the procedure, 10 mL of the microfat was injected through a 6F catheter until the fistula was completely filled. Next, 1-2 mL of tSVFem was injected by a 22G endoscopic needle into the submucosa of the 4 quadrants of the borders of the fistula.

No complications were reported during the procedures. At day 7, all patients exhibited complete fistula healing.

At an average follow-up of 8 months (range, 6-12 months), an upper endoscopy failed to detect luminal strictures among any of the patients and all were asymptomatic.

This study population was based on very few patients and requires additional research to confirm these findings.

The case series authors concluded that with tSVFem, patients had early resolution of their upper GI fistulas, despite their critically ill status. The use of autologous tissue had no risk for graft rejection. These data indicated additional studies of tSVFem are warranted for the treatment of esophageal fistulas.

Disclosure: Multiple authors declared industry affiliations. Please refer to the original article for a full list of disclosures.

Reference

Nachira D, Trivisonno A, Costamagna G, et al. Successful therapy of esophageal fistulas by endoscopic injection of emulsified adipose tissue stromal vascular fraction. Gastroenterol. 2021;160(4):1026-1028. doi: 10.1053/j.gastro.2020.12.063