Refractory gastrocutaneous fistula after gastrostomy removal successfully treated with submucosal dissection and endoscopic suture

Placement of a gastrostomy tube is a basic procedure involving the creation of a gastrocutaneous fistula through which a tube or button device is placed. The tube can be removed when access is no longer required for patients who recover from their disease. The tract starts to close within the first day and usually closes within 3 days. However, a fistula may persist in 25% of cases [1]. Surgical closure has been widely replaced by endoscopic techniques. Various techniques have been described in small patient series: argon plasma coagulation, silver nitrate, biopsy with forceps, endoscopic submucosal dissection or electrocautery can be used for de-epithelization of the fistulous tract. Fibrin glue, clips [2], an over-the-scope clip [3], or bands can be used for closure. Nevertheless, simple means are not always effective and sometimes the combination of mucosal dissection with submucosal closure was described to be effective after failure of standard treatments [4].