Published online Aug 16, 2013. doi: 10.4253/wjge.v5.i8.402
Revised: May 10, 2013
Accepted: June 5, 2013
Published online: August 16, 2013
Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemoclips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gastrointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of minimally invasive endoscopic endoluminal surgery.
Core tip: Herein we present the endoscopic closure of a gastro-colic fistula in a severely malnourished patient with complex post-surgical upper Gastrointestinalanatomy using the over-the-scope-clip (OTSC-system). The OTSC-system is an endoscopic clipping device made of Nitinol, which allows for treatment of peptic ulcer bleeding and the closure of perforations, anastomotic leaks and fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy technique during the same procedure.