Use of an over-the-scope clipping device for closure of a jejuno-sigmoid fistula: a case report with long-term follow-up

Abstract

The over-the-scope clip (OTSC) system is a new technology that enables closure of fistulae which cannot be closed with a conventional clip. A 57-year-old woman had long-term hypoalbuminemia, edema and general malaise. Peroral double-balloon endoscopy (DBE) showed a jejuno-sigmoid fistula and blind loop syndrome of the jejunum and ileum, because ingested food bypassed the ileum through the fistula. She was advised to undergo surgical closure of the fistula, but she refused the procedure. For 7 years following DBE, repeat courses of antibiotics were required to treat bacterial overgrowth due to blind loop syndrome. The fistula was successfully closed using the OTSC system from the sigmoid colon side. The patient's symptoms and quality of life improved. Two years after closure, hypoalbuminemia, edema and general malaise developed again due to dislocation of the OTSC. She then accepted surgical closure of the fistula, because she had experienced improvement after closure using the OTSC. Her quality of life improved again following surgery. OTSC application can demonstrate the improvement expected after surgical closure of a fistula, and may convince a patient of the benefits of surgical closure.

Keywords: Double-balloon endoscopy; Fistula; Long-term outcome; Over-the-scope clip; Therapeutic endoscopy.