Endoscopic Treatment of a Gastrocutaneous Fistula Using the Over-The-Scope-Clip System: A Case Report

Abstract

The over-the-scope-clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) system is a newly designed method for the mechanical compression of large areas in the gastrointestinal tract. So far, indications for OTSC application are hemostasis of primary or postinterventional bleeding, closure of iatrogenic full-thickness or covered perforations. Recently closure of gastrointestinal tract fistulas using this device has been described. A 44-year-old man developed a gastrocutaneous fistula after surgical treatment for a perforated gastric ulcer. We describe the successful endoscopic closure of the fistula using the OTSC system. The patient's clinical followup was uneventful. Fistula closure was successfully implemented as it was documented by imaging and endoscopic examinations performed on the 2nd day and 6th week after the application of the clip. Endoscopic application of the OTSC device was safe and effective for the treatment of a gastrocutaneous fistula.

Performance of the OTSC System in the endoscopic closure of gastrointestinal fistulae - a meta-analysis

“…No author reported explicitly on OTSC device-related complications. No signs of stenosis, necrosis or bleedings at the application site were found (4,6,9,10,12,21). Only Iacopini et al refer to a more pronounced temporary epithelialisation of a clip located at the oesophagogastric junction, albeit without complications.…”

“…However, other studies report on successful application by grasping also fibrotic orifice rims, utilising either the OTSC Anchor (6,9,11,13,21) or the OTSC Twin Grasper (6,10,12,19,20). Hence, success may depend highly on the respective condition, location and shape of the fistulae as well as on the technical experience of the endoscopist with similar situations.…”

“…Hence, success may depend highly on the respective condition, location and shape of the fistulae as well as on the technical experience of the endoscopist with similar situations. Of note, in a number of the examined studies and reports, the OTSC System was utilised in cases where other conventional and surgical firstline treatment approaches had already failed and the fistula was judged as therapy-resistant, underlining OTSC's capacity to close also difficult-to-treat leaks (6,9,11,12,14).…”

“…In three cases (one male/two females between 43 to 45 years old), complete and permanent healing of the respective fistula was verified after two to six weeks follow-up after intervention. Each fistula was closed with one atraumatic OTSC clip (11)(12)(13). In detail, Iacopini et al reported on the closure of two adjacent gastro-cutaneous fistulae located at the oesophagogastric junction in a 45 year-old female patient.…”

Endoscopic closure of a refractory gastrocutaneous fistula using a novel over-the-scope Padlock clip following de-epithelialisation of the fistula tract

“…Understandably, given the patients extensive surgical history, she was not keen to pursue a further operation at this stage. When discussing endoscopic closure and OTSC systems with the patient, we introduced the possibility of using a novel radial closure device (Padlock clip, Diagmed Healthcare Ltd, North Yorkshire, UK) (figure 2) and explained its potential advantages over similar previously used concept systems with a ‘bear-claw’ design, which have been successfully used according to several reports in the literature 8 9 11. The patient made an informed decision to have an attempted endoscopic closure with the Padlock clip.…”