Endoscopic Management of Gastrocutaneous Fistula Using Clipping, Suturing, and Plugging Methods

BackgroundPercutaneous endoscopic gastrostomy (PEG) tube placement is a commonly performed procedure in patients requiring medium to long term enteral feeding and with impaired swallowing. The PEG tract and stoma usually close spontaneously after PEG tube removal. Infrequently, gastrocutaneous fistula develops.Patients and methodsIn this video manuscript, the author reviews and demonstrates different endoscopic management options in approaching gastric fistula: mechanical approximation using through-the-scope endoclips or over-the-scope clipping devices; percutaneous trans-abdominal suture placement; and plugging the fistula tract with biodegradable materials or other tissue adhesives.ConclusionsHealth care providers need to be aware of this uncommon complication after PEG tube removal and management it with appropriate minimally invasive options where expertise and devices are available. Currently, tissue approximation with clips, intra-gastric and/or trans-abdominal suture placement is the preferred endoscopic options for fistula closure.