Endoscopic submucosal dissection-assisted double-layer running suturing technique for closure of a gastrocutaneous fistula.

BACKGROUND AND AIMS: Gastrocutaneous fistulas are rare and challenging adverse events that can have considerably high morbidity and mortality rates. They result from an abnormal connection between the stomach and the skin. They can be caused by various factors, including infection, trauma, anastomotic leaks, and removal of percutaneous endoscopic gastrostomy (PEG) tubes. Endoscopic management of chronic gastrocutaneous fistulas is associated with modest success rates, with reported closure rates of approximately 50%. Effective intervention is necessary to prevent adverse events. We present an endoscopic approach for closing a chronic gastrocutaneous fistula resistant to typical therapy. METHODS: An 85-year-old female patient with a complex history including a previous hiatal hernia repair presented with persistent leakage from a gastrocutaneous fistula after removal of a PEG tube that had been in place for 5 years. Two prior standard endoscopic closure attempts were unsuccessful. We used an advanced endoscopic technique involving mucosal dissection, argon plasma coagulation, and a 2-layer running suture with clip placement. RESULTS: Immediate endoscopic evaluation after the procedure confirmed complete closure without adverse events. At the 3-month follow-up, clinical assessment demonstrated successful closure with resolution of local symptoms. CONCLUSIONS: This case demonstrates the feasibility of an endoscopic submucosal dissection-assisted, double-layer endoscopic suturing approach for the closure of a chronic gastrocutaneous fistula refractory to conventional endoscopic therapies.