Over-the-scope clip to close a gastrocutaneous fistula after esophagectomy

Figure 1 Endoscopic view of purulent secretion flowing out from gastrocutaneous fistula in a 51-year-old man after esophagectomy for esophageal squamous cell carcinoma.

Figure 2 After 42-d drainage with a tube in the wall of the chest together with gastrointenstinal decompression, antibiotic application and parenteral nutrition, there was no obvious purulent secretion from the gastric aspect of the fistula and the diameter of the fistula was about 1 cm × 1 cm.

Figure 3 Appearance of the over-the-scope clip device and it placed on the tip of the endoscope.

Figure 4 Gastric fistula was successfully closed with the 11/6t OTSC system. A: The gastric aspect of the fistula was successfully closed using over-the-scope clip; B: A follow-up endoscopy on 21 d after over-the-scope clip placement found the over-the-scope clip was still in place and the fistula was sealed successfully; C: Closure of the fistula was confirmed by the inability to leak Omnipaque through the stomach to fistula.

Figure 5 Closure of the fistula was confirmed again by the inability to leak Omnipaque through the fistula in chest wall to the stomach.