First report of endoscopic closure of a gastrocolic fistula using an over-the-scope clip system (with video)

摘要

A 41-year-old man with cerebral palsy was referred to our institution with a gastrocolic fistula (GCF) secondary to migration of a PEG tube from the stomach into the transverse colon (TC). The GCF, which was confirmed by CT (A), manifested as intense halitosis and profuse diarrhea upon PEG feeding. At EGD, the GCF was seen to involve the greater curvature of the stomach (B). Intubation of the fistu-lous tract allowed removal of the PEG bumper, which lay within the TC. An over-the-scope clip system (OTSC) (Ovesco AG, Tuebingen, Germany) was mounted onto the gastroscope (C). Once the gastric margins of the GCF were drawn into the OTSC cap by use of a dedicated anchor, clip release successfully closed the GCF (D; Video 1, available online at www.giejournal.org). At 3 months' follow-up, the diarrhea and intense halitosis have not recurred, confirming successful resolution of the GCF and obviating the need for further investigation.