P3356 - Successful Closure of Esophagogastric Fistula: A Novel Approach Utilizing Mantis Endoclips

Jose W. Sotelo, MD¹, Pratyusha Tirumanisetty, MD², Ricardo Badillo, MD^1
1Texas Tech University Health Sciences Center, El Paso, TX; ²Brooklyn Hospital Center, Brooklyn, NY

Introduction: The occurrence of esophagogastric fistula, also known as the "double lumen esophagus," is an uncommon complication that can arise from both open and laparoscopic Nissen fundoplication procedures. In this report, we present a case in which an esophagogastric fistula was successfully treated through endoscopic clip closure.

Case Description/Methods: A 55-year-old female with a medical history of GERD, hiatal hernia post-fundoplication over 10 years prior, and hyperlipidemia presented with progressive intolerance to oral intake. She experienced accompanying symptoms such as nausea, vomiting, new-onset regurgitation, epigastric pain radiating towards the middle chest and throat, and unintentional weight loss of 10-15 pounds over the past month. Her previous hiatal hernia repair had been complicated by persistent dysphagia. A barium esophagogram indicated a possible esophageal perforation. During an endoscopy, a large fistulous communication between the esophagus and the fundoplication wrap was identified, but no intervention was performed due to concerns about exacerbating dysphagia. Subsequent imaging revealed an unusual-appearing type II small paraesophageal hernia with mild reflux and tertiary contractions.

In a subsequent endoscopy performed by our team, a 15 mm fistula was found in the lower third of the esophagus, connecting to the stomach at the level of the fundoplication (Figure A). The fistula was successfully closed using argon plasma coagulation and tissue approximation with three of our new large endoclips (Mantis by Boston Scientific [Figure B]). Subsequent examinations showed no contrast extravasation or perforation. The patient tolerated clear liquids and was discharged with plans for a follow-up endoscopy and Lansoprazole 30 mg. At the 6-week follow-up, the Mantis clips effectively maintained fistula closure, and the patient remained asymptomatic with ongoing GI team follow-up at Texas Tech.

Discussion: Our case report demonstrates the efficacy and safety of utilizing the latest novel endoclips for tissue approximation in the closure and treatment of complex esophageal fistulas.



Disclosures:


Jose W. Sotelo, MD¹, Pratyusha Tirumanisetty, MD², Ricardo Badillo, MD¹. P3356 - Successful Closure of Esophagogastric Fistula: A Novel Approach Utilizing Mantis Endoclips, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.