title: Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system.
abstract: OBJECTIVE
  The Over-The-Scope-Clip (OTSC) has had an evolving role in endoscopic closure of gastrointestinal wall defects, in hemostasis of primary or postinterventional bleeding, and approximation of postbariatric surgery defects. Rapid and effective closure of gastrocutaneous (GC) fistulae using this device has been recently described in the literature. The aim of this study was to evaluate the technical feasibility, efficacy and safety of OTSC as an effective tool in the management of persistent GC fistulae secondary to a complication of percutaneous endoscopic gastrostomy (PEG) tube placement.
  
  
  METHODS
  In this multicenter prospective observational study, we describe our experience with OTSC in the closure of persistent GC fistulas secondary to PEG tube placement. Patients with GC fistulas were sequentially enrolled with a mean age of 84 years. Primary treatment outcome was the immediate successful closure of GC fistula and resolution of leak. Secondary outcome was no recurrence of the fistula and leaks on follow up.
  
  
  RESULTS
  A total of 10 patients were enrolled over the study period. Mean age was 84.4 ± 8.75 years. The primary treatment outcome was achieved in all the patients undergoing this intervention. Secondary outcome was observed in 9/10 (90%) subjects. No procedural complications were reported. Larger fistulae (>2.5 cm) and those with significant fibrosis were more difficult to close with the OTSC system. The mean follow-up time after OTSC application was 43.7 ± 20.57 days. A limitation of this study was that there was no control group.
  
  
  CONCLUSIONS
  OTSC application is a safe and effective endoscopic approach for the closure of persistent GC fistulae secondary to a complication of PEG tube placement.
authors.affiliation: Division of Gastroenterology, The Brooklyn Hospital Center, New York Presbyterian Healthcare System, 121 Dekalb Ave, Brooklyn, NY 11201, USA.
authors.forename: Shashideep
authors.initials: S
authors.lastname: Singhal
authors.affiliation: Division of Gastroenterology, The Brooklyn Hospital Center, New York Presbyterian Healthcare System, Brooklyn NY, USA.
authors.forename: Kinesh
authors.initials: K
authors.lastname: Changela
authors.affiliation: Division of Gastroenterology, St Barnabas Hospital, Bronx, NY, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Culliford
authors.affiliation: Division of Gastroenterology, The Brooklyn Hospital Center, New York Presbyterian Healthcare System, Brooklyn NY, USA.
authors.forename: Sushil
authors.initials: S
authors.lastname: Duddempudi
authors.affiliation: Division of Gastroenterology, The Brooklyn Hospital Center, New York Presbyterian Healthcare System, Brooklyn NY, USA.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnaiah
authors.affiliation: Division of Gastroenterology, The Brooklyn Hospital Center, New York Presbyterian Healthcare System, Brooklyn NY, USA.
authors.forename: Sury
authors.initials: S
authors.lastname: Anand
keywords: OTSC; Over-the-Scope-Clip; endoscopic closure; gastrocutaneous fistula