Over-the-scope clip closure of two chronic fistulas after gastric band penetration

Figure 1 Barium swallow: two fistulas at the esophagogastric junction.

Figure 2 Endoscopic view of the 15-mm (A) and 10-mm (B) fistulous openings on the left and right sides, respectively, above the esophagogastric junction (C).

Figure 3 First OTSC placement. A: Invagination of the proximal segment of the 10-mm fistula into the OTSC applicator cap using the anchor; B: Closure of the 10-mm fistula; C: Barium swallow after the first OTSC and stent placement.

Figure 4 First OTSC completely embedded in hyperplastic overgrowth.

Figure 5 Second OTSC placement. A: Fistula opening reduced in size; B: Fistula closure.

Figure 6 OTSC closure of the two fistulas. A: Two OTSCs in place; B: No leaks from both OTSCs at barium swallow.

Figure 7 Mechanical results of OTSC devices pulling fibrotic margins of chronic perforations. A: Circumferential invagination using the anchor; B: Two-point invagination with the twin grasper.