An 85-year-old woman presented with a 3-month history of weight loss and vomiting
due to a large pancreatic fluid collection arising from the body of the pancreas.
Diagnostic endoscopic ultrasound (EUS) confirmed the fluid was acellular with elevated
amylase and low carcinoembryonic antigen, compatible with a pancreatic pseudocyst.
As the patient remained symptomatic, EUS-guided cystgastrostomy with a 10-mm Hot AXIOS
stent (Boston Scientific, Marlborough, Massachusetts, USA) was performed via the stomach
using a standard approach [1]
[2]
[3], and 1 L of straw-colored fluid drained immediately into the stomach. Following
cyst drainage, the patient improved clinically and was discharged home the next day.
Abdominal computed tomography 1 month later, prior to stent removal, showed resolution
of the pancreatic pseudocyst, but unexpectedly demonstrated that the stent had migrated
into the adjacent colon, creating a gastrocolonic fistula ([Video 1]).
Video 1 Removal of a migrated lumen-apposing metal stent from the colon, followed by endoscopic
closure of a gastrocolonic fistula.
To enable endoscopic removal of the migrated stent, we performed sequential esophagogastroduodenoscopy
(EGD) and colonoscopy, under general anesthesia, following full bowel preparation.
EGD confirmed that the proximal flange of the stent was within the body of the stomach,
draining feculent material. Gastrografin (Bayer, Reading, UK) was injected into the
stent via an endoscopic retrograde cholangiopancreatography (ERCP) cannula and confirmed
a communication with the colon. At colonoscopy with the patient lying in the supine
position, the stent was located at 50 cm, just proximal to the splenic flexure. The
colon was tattooed before stent removal, in case of loss of position. The stent was
then removed from the stomach using grasping forceps and the fistula was closed using
multiple SureClips (Micro-Tech Europe, Düsseldorf, Germany) from the stomach and colonic
sides. Subsequent Gastrografin injection on both sides of the fistula tract confirmed
effective endoscopic closure of the defect. The patient began eating and drinking
the next day and was discharged home 2 days later.
Outpatient review 3 months later confirmed that the patient had no ongoing symptoms
or sequelae following endoscopic closure of the fistula.
Endoscopy_UCTN_Code_CPL_1AL_2AD
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos
