Over-The-Scope Clip (OTSC) Application as Rescue Therapy for Postoperative Enterocutaneous Fistula Closure

Abstract

Background: Postoperative enterocutaneous fistulas are challenging with limited treatment options. The majority of patients with persistent fistula drainage flow require re-surgery. Recently the Over-The-Scope Clip (OTSC® 11/6t, Ovesco Endoscopy, Tubingen, Germany) has become popular in Germany among surgeons and gastroenterologists for closure of perforations and bleeding vessels of the GI tract.

Case report: A 48-year-old female patient suffered from enterocutaneous fistula for four months located at the left upper corner within the enteric anastomosis of the jejunal loop leading to malnourishment. Prior attempts at fistula closure with fibrin glue application failed. An OTSC with sharp teeth (model 11/6t) was placed under continuous suction onto the fistula orifice with consecutive closure. The fistula remained closed even after a follow-up period of 12 months. Conclusions: The authors demonstrate the technical feasibility of fistula closure by OTSC placement even in unfavorable enterocutaneous fistula positions possibly resulting in less surgical re-interventions in the future.

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Notes on contributors

T. Meister

T. Meister, M.D., F.E.B.G. Department of Medicine II Helios Albert-Schweitzer University Teaching Hospital Sturmbaume 8-10 37154 Northeim, Germany Tel.: [phone] Fax: [phone] E-mail: [email protected]