P0457 - Over-the-Scope Clip Closure of Persistent Pancreatico-Colonic Fistula Secondary to Distal Pancreatectomy: A Case Report

Khadija Khan, MD, Maryam Mubashir, MD, Hassaan A. Zia, MD
LSU Health, Shreveport, LA

Introduction: Pancreatico-Colonic Fistula (PCF) is a rare but serious complication that can occur after acute severe pancreatitis, or as a complication following surgery. Failure to treat PCF can lead to sepsis and life threatening hemorrhage. Conventionally surgical repair has been the management, however more recently, Over-the-Scope Clip (OTSC) closure, has shown favorable outcomes. We present a case of successful endoscopic closure of PCF with OTSC.

Case Description/Methods: A 34-year-old man with neuroendocrine tumor (NET) of the tail of pancreas underwent open distal pancreatectomy. Post-operative course was complicated by low grade fevers and leukocytosis. Computed tomography showed loculated fluid collection at the tail of pancreas. A percutaneous drain was placed by Interventional Radiology (IR) team and purulent output was noted. An endoscopic retrograde cholangiopancreatography was performed for suspected pancreatic duct (PD) leak, ventral duct pancreatogram revealed PD leak at the level of the pancreatic tail. PD sphincterotomy was performed and a 7 French x 12 cm straight plastic PD stent with a leading barb was placed. On IR follow up, patient complained of feculent drain output. Fistulogram showed a pancreatic fistula extending to the descending colon. Decision was made to perform a colonoscopy for colonic fistula closure. Colonoscopy findings showed a fistulous tract 55cm from the anal verge, this was confirmed by methylene blue injection via percutaneous drain. The colonoscope was exchanged for an adult upper endoscope and an 11/6t OVESCO OTSC was employed. The endoscope was advanced to the fistulous site and closure was performed. No dye was visualized on repeat methylene blue injection via percutaneous drain. On 1 week clinic follow up, no further drainage from the percutaneous drain was reported by the patient. Subsequent sinogram by IR showed resolution of prior abscess, drain removal was performed.

Discussion: While surgery remains the traditional approach for management of PCF, studies have shown that successful fistula closures using OTSC is safe and effective for fistula sizes < 10 mm. To prevent delayed leakage it is essential to achieve full thickness tissue grasping while correctly positioning the fistula within the OTSC cap.[1] Kobara, et al. Over-the-scope clip system: A review of 1517 cases over 9 years. Journal of Gastroenterology and Hepatology.


Disclosures:


Khadija Khan, MD, Maryam Mubashir, MD, Hassaan A. Zia, MD. P0457 - Over-the-Scope Clip Closure of Persistent Pancreatico-Colonic Fistula Secondary to Distal Pancreatectomy: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.