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Combined endoscopic techniques for closure of a chronic post-surgical gastrocutaneous fistula: case report and review of the literature (with video)

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Abstract

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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Disclosures

Hany M. Shehab and Hady M. Elasmar have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Hany M. Shehab.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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)

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)

Supplementary material 2 (DOCX 14 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

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Keywords

  • Fistula
  • Gastric fistula
  • Endoscopy
  • Natural orifice endoscopic surgery
  • Argon plasma coagulation
  • Bariatric
  • Complications
  • Over-the-scope clip