[Endoscopic closure of a chronic colonic fistula using the over-the-scope clip (OTSC)]

A 64 year old male patient suffered from recurrent subphrenic abscesses following a complicated postoperative course after sigmoidectomy for chronic recurrent diverticulitis. Two previous attempts of abscess treatment by transcutaneous drainage had failed. Radiographic studies eventually showed a fistula of the descending colon leading to the abscess formation, which could be identified and confirmed endoscopically by installation of dye.

Endoscopic application of an "over-the-scope clip" (OTSC) onto the anchor-retracted enteric fistula orifice led to complete closure of the fistula within four days as demonstrated by radiographic studies and repeat dye installation. Subsequently the transcutaneous drainage could be gradually retracted and eventually successfully removed within 14 days of OTSC application without recurrence of abscess formation.

The OTSC is a recently developed endoscopic tool, allowing the application of a large claw-like clip for endoscopic closure of full thickness enteric wall defects and cessation of large vessel bleeding within the gastrointestinal tract. It is a novel tool which can be safely and successfully employed to endoscopically close a fistula of the lower intestinal tract. Future controlled multicenter-studies should address the usefulness of OTSC in the conservative-endoscopic management of intestinal fistulizing disease.