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Published on: April 24, 2014
PEG closure in the second attempt
Leif Schiffmann1, Marin Roth2, Florian Kuehn3
1Westmecklenburg-Klinikum, Hagenow, Germany; Evangelische Krankenhaus Lippstadt, Lippstadt, Germany; Rostock University Medical Center, Rostock, Germany.
Endoscopic closure of a persistent gastrocutaneous fistula was achieved using a larger over-the-scope clip (OTSC) after initial failure. This technique offers a solution for complex post-gastrostomy tube fistula management.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Gastrointestinal Tract Disorders
Background:
- Persistent gastrocutaneous fistulas can complicate percutaneous endoscopic gastrostomy (PEG) tube removal.
- Management of such fistulas, especially in immunocompromised patients like those post-lung transplant, presents challenges.
Observation:
- A 21-year-old patient with cystic fibrosis post-lung transplantation developed a persistent gastrocutaneous fistula after PEG removal.
- Initial endoscopic attempt using a standard gastric OTSC clip failed to achieve complete fistula closure.
Findings:
- A second endoscopic intervention successfully closed the fistula using a larger colon OTSC clip.
- This demonstrates the adaptability of OTSC clipping for complex fistula closure.
Implications:
- Endoscopic OTSC clipping is a viable treatment for persistent gastrocutaneous fistulas.
- Larger OTSC clips can be employed for refractory cases, offering a less invasive alternative to surgery.
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