Case Report
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World J Gastrointest Endosc. Aug 16, 2013; 5(8): 402-406
Published online Aug 16, 2013. doi: 10.4253/wjge.v5.i8.402
Endoscopic closure of a gastrocolic fistula using the over-the-scope-clip-system
Klaus Mönkemüller, Shajan Peter, Basem Alkurdi, Jayapal Ramesh, Daniel Popa, C Mel Wilcox
Klaus Mönkemüller, Shajan Peter, Basem Alkurdi, Jayapal Ramesh, Daniel Popa, C Mel Wilcox, Division of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, Birmingham, AL 35249, United States
Author contributions: All the authors substantial contributed to conception and design, acquisition of data, or analysis and interpretation of data, revising the article critically for important intellectual content and final approval of the version to be published; Mönkemüller K and Popa D contributed to drafting the article.
Correspondence to: Klaus Mönkemüller, MD, PhD, FASGE, Division of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, JT 664, 619 19th Street S, Birmingham, AL 35249, United States. klaus1@uab.edu
Telephone: +1-205-9346110 Fax: +1-205-9341537
Received: April 14, 2013
Revised: May 10, 2013
Accepted: June 5, 2013
Published online: August 16, 2013
Processing time: 121 Days and 6.7 Hours
Abstract

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.

Keywords: Over-the-scope-clip; Bear claw; Fistula; Endoscopic closure; Gastrocolic fistula; Over the scope clip; Clip

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.