Reopening of a gastrocutaneous fistula (GCF) many years after gastrostomy tube removal is extremely uncommon 1 2. In long-standing fistulas, the tract often becomes epithelialized with gastric mucosa, forming a rigid, mature channel. We report a rare case of GCF reopening 18 years after gastrostomy tube removal that was successfully closed using argon plasma coagulation (APC) followed by endoscopic hand suturing (EHS). A 60-year-old woman with familial adenomatous polyposis had undergone total colectomy for colon cancer and surgical treatment for a ureteral desmoid tumor 23 years earlier. A percutaneous endoscopic gastrostomy was placed postoperatively for nutritional support and was removed once oral intake had recovered. The fistula closed spontaneously, and she remained asymptomatic for the following 18 years. Subsequently, gastric leakage developed from the previous gastrostomy site, leading to abdominal skin dermatitis caused by exposure to gastric fluid (Fig. 1). Esophagogastroduodenoscopy (EGD) revealed a fistulous opening on the greater curvature of the antrum (Fig. 2). Endoscopic clip closure was attempted; however, the closure was unsuccessful. As the fistulous tract was epithelialized in the endoscopically visible portion of the tract, APC was applied to ablate the mucosa and create a fresh ulcer bed (Fig. 3). EHS using the SutuArt system (Olympus, Co. , Ltd, Tokyo, Japan) was subsequently performed (Fig. 4), and six sutures were placed around the fistulous orifice to achieve complete closure (Fig. 5). Follow-up EGD at 1 month confirmed sustained closure (Video 1). Although the mechanism of late fistula reopening remains unclear, this case illustrates that a combined endoscopic approach using APC and EHS offers a valuable, minimally invasive option for managing long-standing or recurrent GCF. EndoscopyUCTNCodeTTT₁AO₂AO Article published online: 30 January 2026 © 2026. The Author (s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https: //creativecommons. org/licenses/by/4. 0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Yokoyama et al. (Fri,) studied this question.