title: First report of colonoscopic closure of a gastrocolocutaneous PEG migration with over-the-scope-clip-system.
abstract: Percutaneous endoscopic gastrostomy (PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemicolectomy many years ago due to unknown reason. Laryngectomy was indicated. Preoperatively a PEG was inserted endoscopically after an abdominal ultrasonography without abnormal findings. Few months after PEG insertion, the patient was evaluated for diarrhea and insufficient feeding without signs of infection or peritonism. An upper endoscopy and computed tomography scan confirmed a buried bumper syndrome with migration of the PEG tube into the colon as a rare complication. He underwent successful colonoscopic removal of the internal bumper and closure of the colonic orifice of the fistula with the over-the-scope-clip system (OTSC). OTSC is an endoscopic device for treatment of bleeding, perforation, leak and fistula in the gastrointestinal tract. To the best of our knowledge, this is the first report of the use of OTSC for colonoscopic closure of a gastrocolocutaneous fistula due to a buried bumper syndrome with transcolonic PEG tube migration.
authors.affiliation: Reto Bertolini, Christa Meyenberger, Michael Christian Sulz, Department of Gastroenterology and Hepatology, 9000 St. Gallen, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Bertolini
authors.affiliation: Reto Bertolini, Christa Meyenberger, Michael Christian Sulz, Department of Gastroenterology and Hepatology, 9000 St. Gallen, Switzerland.
authors.forename: Christa
authors.initials: C
authors.lastname: Meyenberger
authors.affiliation: Reto Bertolini, Christa Meyenberger, Michael Christian Sulz, Department of Gastroenterology and Hepatology, 9000 St. Gallen, Switzerland.
authors.forename: Michael Christian
authors.initials: MC
authors.lastname: Sulz
mesh_terms: D000369:Aged, 80 and over; D003106:Colon / Q000000981:diagnostic imaging / Q000601:surgery*; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation*; D020878:Device Removal / Q000295:instrumentation* / Q000379:methods; D004750:Enteral Nutrition / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D013525:Surgical Instruments; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Buried bumper; Colon; Complication; Enterocutaneous fistula; Migration; Over-the-scope-clip; Over-the-scope-clip system; Percutaneous endoscopic gastrostomy