Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques

Figure 6 Gastrocutaneous fistula. A: External appearance of a gastrocutaneous fistula in the first case; B: Endoscopic appearance of the gastrocutaneous fistulous orifice; C: Endoscopic closure of the gastric fistulous orifice with an over-the-scope metal clip in the first case (OTSC – Ovesco Endoscopy AG, Tubingen, Germany); D: Endoscopic appearance of a large gastrocutaneous fistula, with detection of the gauze placed from the outside at the cutaneous end of the tract (red arrow) in the second case; E: Endoscopic placement of four metal clips at the margins of the fistulous orifice; F: Placement of an endoloop over the metal clips to achieve complete closure of the fistulous orifice.