Case Report
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Apr 7, 2010; 16(13): 1665-1669
Published online Apr 7, 2010. doi: 10.3748/wjg.v16.i13.1665
Over-the-scope clip closure of two chronic fistulas after gastric band penetration
Federico Iacopini, Nicola Di Lorenzo, Fabrizio Altorio, Marc-Oliver Schurr, Agostino Scozzarro
Federico Iacopini, Agostino Scozzarro, Gastroenterology and Endoscopy Unit, Ospedale San Giuseppe, Albano Laziale, Roma 00041, Italy
Nicola Di Lorenzo, Fabrizio Altorio, Department of Surgical Science, Policlinico Università di Tor Vergata, Roma 00173, Italy
Marc-Oliver Schurr, Steinbeis University Berlin, IHCI-Institute, Tuebingen D-72076, Germany
Author contributions: Iacopini F, Di Lorenzo N, Altorio F and Scozzarro A contributed to this work; Iacopini F analyzed data and wrote the paper; Schurr MO revised the paper.
Correspondence to: Agostino Scozzarro, MD, Gastroenterology and Endoscopy Unit, Ospedale San Giuseppe, Via dell’Olivella, Albano Laziale, Rome 00041, Italy.
Telephone: +39-6-93273938 Fax: +39-6-93273216
Received: October 19, 2009
Revised: November 17, 2009
Accepted: November 24, 2009
Published online: April 7, 2010

Gastrointestinal perforations are conservatively managed at endoscopy by through-the-scope endoclips and covered self expandable stents, according to the size and tissue features of the perforation. This is believed to be the first report of successful closure of two gastro-cutaneous fistulas with over-the-scope clips (OTSCs). After laparoscopic gastric banding, a 45-year old woman presented with band erosion and penetration. Despite surgical band removal and gastric wall suturing, external drainage of enteric material persisted for 2 wk, and esophagogastroduodenoscopy demonstrated two adjacent 10-mm and 15-mm fistulous orifices at the esophagogastric junction. After cauterization of the margins, the 10-mm fistulous tract was grasped by the OTSC anchor, invaginated into the applicator cap, and closed by a traumatic OTSC. The other 15-mm fistula was too large to be firmly grasped, and a fully-covered metal stent was temporarily placed. No leak occurred during the following 6 wk. At stent removal: the OTSC was completely embedded in hyperplastic overgrowth; the 15-mm fistula significantly reduced in diameter, and it was closed by another traumatic OTSC. After the procedure, no external fistula recurred and both OTSCs were lost spontaneously after 4 wk. The use of the anchor and the OTSC seem highly effective for successful closure of small chronic perforations.

Keywords: Gastrointestinal endoscopy, Fistula, Stent, Esophagogastric junction