Endoscopic closure instead of surgery to close an ileal pouch fistula with the over-the-scope clip system

Abstract

An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip (OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the “J” pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the “J” pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgery-related complications.

Keywords: Over-the-scope clip system, Endoscopic treatment, Restorative proctocolectomy, Ulcerative colitis, Ileal pouch fistula

Core tip: Leaks from the tip of the J-pouch are less likely to occur but are associated with pouch failure after ileal pouch-anal anastomosis. Salvage surgery has been commonly performed to resolve these leaks, and the surgery typically includes laparotomy with either pouch repair or pouch resection. In this report, we present a patient with a fistula on the tip of the “J” in the pouch who was successfully treated with the over-the-scope clip system. We propose that this method could be used as an alternative to surgery to avoid surgery-related complications in patients with pouch fistula.