What's next after failure of OTSC® for the closure of gastrostomy fistula? Another OTSC®?

A 55-year-old female patient was diagnosed with squamous cell carcinoma of the nasopharynx stage in 2016 and proposed for radical chemo/radiotherapy. A percutaneous endoscopy gastrostomy was performed in 2016 because of the patient´s difficulty in swallowing. The patient had good response to therapy with disease´s remission so the gastrostomy tube was removed in 2018. After two weeks of conservative management, the patient maintained a gastrocutaneous fistula with extravasation of liquid contents. Endoscopic closure with over the scope clip (OTSC®) was performed.