Endoscopic closure of duodenocolic fistula by using an over-the-scope clip

A 61-year-old woman was admitted to the hospital because of persistent vomiting and diarrhea for the past year. In esophagogastroduodenoscopy performed for the etiology of these symptoms, a fistula was seen in the descending part of the duodenum without any erosion and ulceration. The fistula mouth was about 8 mm wide, and endoscopy was used to view the transverse colon from the fistula mouth ([Fig. 1]). Colonoscopy revealed the fistula mouth in the hepatic flexure and diverticulum nearby ([Fig. 2]). No additional pathology such as tumors or ulcers was seen in the duodenum and colon. During esophagogastroduodenoscopy, the fistula on the descending part of the duodenum was closed by performing suction and using an over-the-scope (OTS) clip (12/6/t; Ovesco Endoscopy AG, Tubingen, Germany) ([Fig. 3]; [Video 1]). When the fistula mouth was checked with colonoscopy, it was observed to be closed ([Fig. 4]). Oral intake started the day after the procedure and there were no problems. As a result, in selected cases, an OTS clip is an effective and safe method in full-thickness closure of transmural defects such as duodenocolic fistula [1] [2] [3] [4].

Fig. 1 Esophagogastroduodenoscopy and fistula in the descending part of the duodenum.

Fig. 2 Colonoscopy and fistula mouth in the hepatic flexure.

Fig. 3 Final view of the duodenocolic fistula after placement of the over-the-scope clip (12 /6 t).

Video 1 Duodenocolic fistula treated with over-the-scope clip (12/6t).

Fig. 4 Colonoscopy and closed view of the fistula mouth in the hepatic flexure.

Endoscopy_UCTN_Code_TTT_1AO_2AI

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Ocana RS, Herbozo CC, Marrero AF. et al. Endoscopic clip closure of a duodenocolic fistula secondary to a migrated biliary stent. Endoscopy 2016; 48: 230-231
• 2 Mizrahi I, Eltawil R, Haim N. et al. The clinical utility of over-the-scope clip for the treatment of gastrointestinal defects. J Gastrointest Surg 2016; 20: 1942-1949
• 3 Mennigen R, Colombo-Benkmann M, Senninger N. et al. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the over-the-scope clip (OTSC). J Gastrointest Surg 2013; 17: 1058-1065
• 4 Manta R, Manno M, Bertani H. et al. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy 2011; 43: 545-548

Publikationsverlauf

Artikel online veröffentlicht:
08. September 2021