ENDOSCOPIC CLOSURE OF A COLOCUTANEOUS FISTULA AFTER PEG PLACEMENT

A 16-year-old boy with medical history of neurofibromatosis type-1 and malignant peripheral nerve sheath tumor underwent PEG tube placement due to dysphagia, anorexia and malnutrition. After PEG replacement, patient started with persistent diarrhea and weight loss. A contrast study revealed a colocutaneous fistula, as contrast infused through the PEG appeared in the colon. For endoscopic closure, fistula edges were fulgurated with argon-plasma and after, we placed two 14/6 mm over-the-scope-clip (OTSC); finally, a detachable snare was placed beneath both OTSC jaws, with the help of a foreign body retrieval forceps. Percutaneous stool leaking completely stopped 2 days later, confirming fistula closure.