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Case Reports
. 2011:2011:384143.
doi: 10.1155/2011/384143. Epub 2011 May 29.

Endoscopic treatment of a gastrocutaneous fistula using the over-the-scope-clip system: a case report

Georgios Kouklakis  1 , Petros Zezos, Nikolaos Liratzopoulos, Anthia Gatopoulou, Anastasia Oikonomou, Michail Pitiakoudis, Eleni Efremidou, Constantinos Simopoulos
Affiliations
Case Reports

Endoscopic treatment of a gastrocutaneous fistula using the over-the-scope-clip system: a case report

Georgios Kouklakis et al. Diagn Ther Endosc. 2011.

Abstract

The over-the-scope-clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) system is a newly designed method for the mechanical compression of large areas in the gastrointestinal tract. So far, indications for OTSC application are hemostasis of primary or postinterventional bleeding, closure of iatrogenic full-thickness or covered perforations. Recently closure of gastrointestinal tract fistulas using this device has been described. A 44-year-old man developed a gastrocutaneous fistula after surgical treatment for a perforated gastric ulcer. We describe the successful endoscopic closure of the fistula using the OTSC system. The patient's clinical followup was uneventful. Fistula closure was successfully implemented as it was documented by imaging and endoscopic examinations performed on the 2nd day and 6th week after the application of the clip. Endoscopic application of the OTSC device was safe and effective for the treatment of a gastrocutaneous fistula.

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Figures

Figure 1
Figure 1
Upright posteroanterior chest radiograph: there is free subdiaphragmatic air bilaterally that is more clearly noted on the left side (white arrows).
Figure 2
Figure 2
The cutaneous orifice of the fistula discharging gastric juice.
Figure 3
Figure 3
Upper GI study with gastrografin showing a gastrocutaneous fistula (arrow).
Figure 4
Figure 4
The OTSC system.
Figure 5
Figure 5
The gastric orifice of the gastrocutaneous fistula (arrow) during endoscopic application of the OTSC device.
Figure 6
Figure 6
Immediate postinterventional endoscopic view. The tissue at the gastric orifice was captured with OTSC, and the fistula orifice was successfully sealed (arrow).
Figure 7
Figure 7
Upper GI study with gastrografin 48 hours after procedure, showing the gastric OTSC in place (arrows) without leaks of contrast media.
Figure 8
Figure 8
Postinterventional followup after 6 weeks. The cutaneous orifice was completely healed.
Figure 9
Figure 9
Postinterventional followup after 6 weeks. Endoscopic view of the OTSC in situ with gastric fistula orifice closure (arrow).
Figure 10
Figure 10
Postinterventional followup after 6 weeks. Gastrografin upper GI study showing the gastric OTSC in place (arrow) without leaks of contrast media.
See this image and copyright information in PMC

References

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