Endoscopy 2021; 53(02): E42-E43
DOI: 10.1055/a-1177-9952
E-Videos

Wire-guided over-the-scope clip method for closing gastrobronchial fistula

Bulent Odemis
Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
,
Dilara Turan Gökçe
Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
› Institutsangaben
 

Gastric fistula is a significant complication that develops in 0.9 % – 2.6 % of cases after bariatric surgery [1]. Although gastrobronchial fistula (GBF) is a rare gastric fistula, it can generally be treated with thoracotomy and laparotomy but with high mortality rates.

A 52-year-old man who had undergone a mini-gastric bypass operation (preoperative body mass index 38 kg/m2) 4 months earlier was admitted to our hospital with GBF and secondary complications. Endoscopic evaluation revealed a fibrotic fistula orifice, approximately 7 – 8 mm in diameter, in the proximal fundus ([Fig. 1]). A balloon catheter loaded with a guidewire was inserted into the fistula tract. Fistulography showed leakage of contrast medium into the left subdiaphragmatic area and left bronchus ([Fig. 2]). After checking the cavity with the balloon, the wire was left in the fistula tract and the endoscope was removed ([Video 1]). The endoscope was loaded with a 12-mm over-the-scope clip (OTSC) and reinserted into the fistula tract over the wire. The OTSC was deployed and the fistula orifice was closed, with the wire in the center of the clip. The wire was removed easily from the middle of the clip. Fluoroscopy confirmed no contrast leakage into the fistula tract, and endoscopy showed the fistula orifice to be totally closed ([Fig. 3]). The patient was completely well during the first year of follow-up.

Zoom Image
Fig. 1 Endoscopic view of fibrotic fistula orifice in the proximal fundus.
Zoom Image
Fig. 2 Fistulography showed leakage of contrast medium into the subdiaphragmatic area (arrow) and the left bronchus (arrowhead).

Video 1 The wire-guided technique for closure by over-the-scope clip.


Qualität:
Zoom Image
Fig. 3 On endoscopy, the fistula orifice appeared to be completely closed.

Unlike classical closure methods, the OTSC method used in this case involved wire guidance, with the wire still in place when the fistula orifice was closed. This wire-guided OTSC method, which has been reported previously [2], was preferred to the use of the OTSC Anchor and Twin Grasper (Ovesco, Tübingen, Germany) because it reduces the mobility of the OTSC through close proximity to the lumen wall, and suction can be performed without damage to fibrotic tissue.

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Dilara Turan Gökçe, MD
Department of Gastroenterology, Ankara City Hospital
Bilkent Boulevard No: 1
Ankara 06105
Turkey   
Fax: +90-543-5484378   

Publikationsverlauf

Publikationsdatum:
02. Juni 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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Zoom Image
Fig. 1 Endoscopic view of fibrotic fistula orifice in the proximal fundus.
Zoom Image
Fig. 2 Fistulography showed leakage of contrast medium into the subdiaphragmatic area (arrow) and the left bronchus (arrowhead).
Zoom Image
Fig. 3 On endoscopy, the fistula orifice appeared to be completely closed.