Endoscopic management of a complex gastrocolojejunal fistula following endoscopic ultrasound-guided gastrojejunostomy.

BACKGROUND AND AIMS: EUS-guided gastrojejunostomy (EUS-GJ) is an effective minimally invasive treatment for gastric outlet obstruction. However, misdeployment can result in complex fistulas with significant morbidity. We describe successful endoscopic management of a gastrocolojejunal (GCJ) fistula following EUS-GJ.

METHODS

A 69-year-old male developed a GCJ fistula post-EUS-GJ, presenting with septic shock. Initial bridging was performed using 2 telescoping lumen-apposing metal stents and a coaxial fully covered metal stent. Definitive closure was attempted endoscopically using a double-channel gastroscope with OverStitch (Boston Scientific, Marlborough, Mass, USA) and over-the-scope clips (OTSCs).

RESULTS

The colojejunal and gastrocolic fistulas were successfully closed with running 2.0 polypropylene sutures and OTSC reinforcement. Fluoroscopy confirmed a complete seal, and follow-up endoscopy showed intact closure without leaks or adverse events.

CONCLUSIONS

Endoscopic suturing with clip reinforcement is a safe and effective alternative to surgery for complex post-EUS-GJ fistulas in high-risk patients.