Several techniques have been proposed to seal post-operative leaks endoscopicaly, however, chronic fibrosed fistulas remain a tenacious problem. We describe the success of a combination of minimally invasive peroral endoscopic techniques to seal and permanently close a chronic gastrocutaneous fistula complicating a laparoscopic gastric bypass, these techniques included: fistuloscopy, argon plasma coagulation, mucosal stripping and the novel over-the-scope clips.
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Hany M. Shehab and Hady M. Elasmar have no conflicts of interest or financial ties to disclose.
Electronic supplementary material
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Video 1. Detection of the fistula and a view inside the fistula showing its chronic nature with well-epithelialized walls. Next, argon plasma coagulation (APC) is applied to the proximal end of the fistula. The twin-grasper then is used to induce multiple small circumferential tears at the edges of the fistula followed by application of the over-the-scope clip (OTSC). (MPG 119414 kb)
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Shehab, H.M., Elasmar, H.M. Combined endoscopic techniques for closure of a chronic post-surgical gastrocutaneous fistula: case report and review of the literature (with video). Surg Endosc 27, 2967–2970 (2013). https://doi.org/10.1007/s00464-013-2839-1
- Gastric fistula
- Natural orifice endoscopic surgery
- Argon plasma coagulation
- Over-the-scope clip