Clin Endosc.  2015 Nov;48(6):563-565. 10.5946/ce.2015.48.6.563.

Utility of Over-the-Scope Clipping for Closure of a Persistent Post-Percutaneous Endoscopic Gastrostomy Fistula under Long-Term Steroid Therapy

• Arao Y
• Sato Y
• Hashimoto
• Honda H
• Yoko K
• Takamura M
• Mizuno KI
• Kobayashi

• KMID: 2380417
• DOI: http://doi.org/10.5946/ce.2015.48.6.563

Abstract

A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.

Keyword

Over-the-scope clipping; Fistula; Percutaneous endoscopic gastrostomy tube; Fibrosis; Steroids

MeSH Terms

Eating
Female
Fibrosis
Fistula*
Gastrostomy*
Humans
Inflammation
Lupus Erythematosus, Systemic
Middle Aged
Pharyngeal Neoplasms
Prednisolone
Steroids
Wound Healing
Prednisolone
Steroids

Figure

• 

  Fig. 1. Endoscopic findings. (A) Endoscopic view showing a fistula of 4 mm in diameter. (B) An attempt to close the fistula with endoclips failed. (C) The fistula was identified endoscopically by tube insertion through the fistula. (D) The fistula was successfully closed with over-the-scope clipping.

• 

  Fig. 2. Endoscopic findings. (A) The over-the-scope clipping (OTSC) clip 2 days after the procedure. (B) The OTSC clip was covered with regenerating mucosa 13 days after the procedure.

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