Sealing the gap: a hybrid stitch approach to gastrostomy closure

Leakage of gastric contents is an uncommon adverse event associated with gastrostomy. Its management is often challenging and of limited efficacy.

A 30-year-old woman with spastic cerebral palsy who had undergone surgical gastrostomy was admitted with persistent peristomal leakage of gastric contents. Initial management with temporary tube removal to promote stoma reduction, combined with antisecretory therapy and prokinetics, proved unsuccessful. Endoscopic closure was then attempted, but clip anchoring was hindered by extensive fibrosis. Cyanoacrylate injection with external orifice suturing also failed. A novel hybrid transmural suturing technique under endoscopic guidance was then performed: argon plasma coagulation was applied along the fistula tract; 2 Abbocath catheters (B. Braun Medical Inc, Bethlehem, Pa, USA) were placed percutaneously into the stomach; a suture and a looped guidewire were placed through each catheter; the suture was then retrieved and exteriorized to allow a simple surgical knot; and finally, cyanoacrylate was applied.

Upon discharge, complete resolution of leakage was achieved, with no recurrence at the 2-month follow-up.

This case illustrates the successful application of an innovative suturing technique as an effective therapeutic alternative for persistent gastrostomy leakage in patients with high surgical and anesthetic risk.