- A 40-year-old woman had a history of epilepsy and global developmental delay after placement of a percutaneous endoscopic gastrostomy (PEG) tube 25 years earlier. She had an 18F gastrostomy tube exchanged every 2 months. During the past year, the stoma had increased in size progressively, and the patient presented with PEG site leakage. An initial attempt at gastrocutaneous fistula (GCF) closure with both an over-the-scope clip and endoscopic suturing was not possible because of a narrow mouth aperture.
- A 60-year-old woman presented with achalasia (subtype I) with a large epiphrenic diverticulum as shown by EGD. The patient was not agreeable to surgical therapy; hence, a 2-stage endoscopic approach was developed (Fig. 1; Video 1, available online at www.giejournal.org ). First, a per-oral endoscopic myotomy (POEM) was performed. Next, the patient underwent endoscopic creation of a fistula from the esophageal diverticulum to the gastric fundus. The fistula was then dilated with a biliary dilation balloon.
- EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for the management of gastric outlet obstruction (GOO). During EUS-GE, creation of a fistula tract can be challenging because the small bowel tends to move away from the stomach. We describe a novel method to secure the guidewire, permitting safe creation of a gastroenterostomy fistula. The first patient was a 48-year-old man with a history of chronic calcific pancreatitis complicated by duodenal stricture and GOO. Multiple endoscopic balloon dilations were performed, without durable benefit.
- A 48-year-old woman presented with progressive abdominal pain 2 weeks after she had undergone laparoscopic sleeve gastrectomy (SG). A CT scan of the abdomen demonstrated postsurgical changes related to SG and a large extraluminal collection containing fluid, debris, and air adjacent to the surgical staple line. A percutaneous drain was placed, and endoscopic closure of the defect was attempted. Endoscopy revealed a fistulous opening adjacent to normal gastric lumen. The internal orifice of the gastrocutaneous (GC) fistula conditioned a pouch-like lumen, which was divided from the gastric lumen by a 15-mm-long septum (Fig. 1A).
- The lumen-apposing stent (Axios, Xlumena Inc, Mountain View, Calif) has been used for endoscopic management of pseudocyst and gallbladder drainage with very high technical and clinical success. Even though it has bilateral large flanges to prevent migration, stent migration and dislodgement have been reported in 5% of patients.