Persistent gastrocutaneous fistula (GCF) is a possible complication after removal of a long-term implanted gastrocutaneous tube.1 We report endoscopic hand suturing (EHS) combined with radiofrequency coagulation to successfully close a refractory GCF not resolved using conventional endoscopic or surgical procedures (Fig. 1).
Fig. 1.
Endoscopic hand suturing combined with radiofrequency coagulation to close a refractory gastrocutaneous fistula. (A) Fistula after removal of the gastrocutaneous tube. (B) Attempt to close fistula by clipping, in which closure could not be maintained. (C) The mucosa around the fistula was cauterized using hemostatic forceps. (D) Endoscopic hand suturing with a SutuArt instrument. (E) Additional clipping was performed on the sutures. (F) At 1 month post-surgery, the clip remained in place and closure was maintained.
A 70-year-old man underwent gastrostomy for dysphagia associated with neuro-Behçet disease. One year later, he was able to consume food orally, and his gastrostomy tube was removed. The resulting fistula did not close spontaneously and began to copiously leak gastric contents. A purse-string suture against the skin did not reduce leakage. Endoscopic clipping and application of a polyglycolic acid sheet were also performed, but did not maintain closure.
The GCF was deemed refractory, and EHS with SutuArt (Olympus Co. Ltd.)2 was performed using V-Loc 180 absorbable barbed sutures (VLOCL0604; Covidien) (Video 1). Endoscopic procedures were performed using a GIF-H290T endoscope with a single accessory channel (Olympus Co. Ltd.). The mucosa around the fistula was first cauterized using hemostatic forceps to create an artificial ulcer. A VIO300D electrosurgical system (ERBE Elektromedizin GmbH) with soft coagulation (5–80 watts) was used. Four continuous stitches were placed with firm engagement of the submucosal layer. No pre-procedural or peri-procedural antibiotics were administered. The patient resumed oral intake the day after procedure. No further leakage was observed. One month later, the clip remained in place and closure was maintained.
Unlike the OverStitch endoscopic suturing device (Apollo Endosurgery), which requires a double-channel endoscope, the SutuArt can be used with a single-channel scope and allows for more delicate and precise manipulation. Successful EHS using SutuArt to repair a GCF has also been reported.3 Coagulation-induced inflammatory stimuli facilitate granulation tissue formation. To promote stronger tissue adhesion, an artificial ulcer was created using radiofrequency coagulation before suturing. This procedure may become the standard treatment for refractory GCF.
Footnotes
Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
None.
Acknowledgments
Informed consent was obtained from the patient for the publication of this case report.
Author Contributions
Conceptualization: AG, SI; Methodology: KH, SH, JN; Supervision: TT; Writing–original draft: AG; Writing–review & editing: all authors.
Video
Endoscopic hand suturing with SutuArt and radiofrequency coagulation for gastrocutaneous fistula.
A video related to this article can be found online at https://doi.org/ce.2025.206.
REFERENCES
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Supplementary Materials
Endoscopic hand suturing with SutuArt and radiofrequency coagulation for gastrocutaneous fistula.