When Gastrostomy becomes Colostomy – Closure of colocutaneous fistula with OTS-clip

Colonic transfixation is an infrequent adverse event of percutaneous endoscopic gastrostomy (PEG) placement, complicating with the formation of a colocutaneous fistula. The best therapeutic strategy is not well defined, given the rarity and variability of the clinical presentation: conservative, surgical or endoscopic approaches are described in the literature, including the placement of an over-the-scope clip (OTS-clip) in some cases. We present the case of a 78-year-old female patient with a personal history of dysphagia in the context of a stroke and amyotrophic lateral sclerosis, leading to PEG placement. After PEG replacement, she started complains of watery diarrhea and drainage of fecal content through the tube, coming to the Emergency Department 10 days after the onset of symptoms. On blood analysis, she had hypokalemia and elevated inflammatory parameters. An abdomino-pelvic computed tomography scan revealed a PEG button in the sigmoid colon. An upper gastrointestinal endoscopy was performed and no mucosal discontinuity was observed at the previous gastrostomy site. It was decided to carry out colonoscopy for endoscopic closure of the colocutaneous fistula. After identifying the PEG button, the probe was removed and the orifice of the colocutaneous fistula was closed using a 12/6t OTS-clip with the aid of an anchoring device. The skin was also sutured. The patient evolved favorably after a course of antibiotic therapy with closure of the fistula and reintroduction of enteric diet through nasogastric tube. Detailed iconography of the endoscopic procedure in video format will be presented. This is a case of interest due to the infrequent complication of PEG placement, with the possibility of endoscopic treatment, which we present in detail [1].

Publication History

Article published online:
27 March 2025

• References

• 1 Bertolini R., Meyenberger C., Sulz M.C.. First report of colonoscopic closure of a gastrocolocutaneous PEG migration with over-the-scope-clip-system. World journal of gastroenterology 2014; 20 (32): 11439-11442