1889 Endoscopic Closure of Gastrocolic Fistula Using Hemostatic Clips: A Novel Approach

Abstract

INTRODUCTION: Traditionally, surgery is the mainstay of treatment for gastrointestinal fistulas; more recently, however, therapeutic endoscopic stent placement is being explored for high-risk patients. Successful endoscopic closure of these fistulas using hemostatic clips offers the possibility of an alternative, viable approach for patients who are nonsurgical candidates and may benefit from noninvasive endoscopic interventions. CASE DESCRIPTION/METHODS: An 82-year-old male with history of peptic ulcer disease, alcohol abuse, and Billroth II gastrojejunostomy >20 years ago was admitted due to bloody diarrhea. Physical examination was unremarkable except for melena. Laboratory testing revealed a hemoglobin level of 4.6g/dL. After resuscitation, upper endoscopy was performed and the patient was found to have a mucosal perforation at the anastomotic site with an adjacent clean-based ulcer (A, B) without active bleeding. The mucosal defect was closed using four hemostatic clips (C). Abdominal CT scan later confirmed a gastrocolic fistula successfully closed with clip placement (D). The patient’s symptoms resolved; his remaining hospital course was uncomplicated. DISCUSSION: Intervention during endoscopy precluded the need for surgical intervention in an elderly patient who would otherwise have been a poor surgical candidate. To the best of our knowledge, this is the first use of hemostatic clip placement for closure of a gastrocolic fistula.