Repair of a gastrocolic fistula using a wire-guided, simultaneous dual scope approach.

A 72-year-old manwith a history of diverticulitis 1 year previously, requiring a partial colectomy, presented to our hospital complaining of fever and weight loss over the preceding 3 weeks. Blood cultures revealed Gram-negative bacteremia. Antibiotics were initiated and a complete workup for infectious diseases was done without any success. Barium imaging and computed tomography (CT) of his abdomen revealed a 14-cm long fistulous tract extending from the greater curvature of the stomach to the area of the sigmoid colon (●" Fig.1). It was felt that the bacteremiawasmost likely due to the gastrocolic fistula and endoscopic closure was planned. At upper endoscopy, the gastric fistula opening was visualized on the greater curvature of the gastric body (●" Fig.2). After injection of contrast into the tract, a 0.025-cm Jag wire (Boston Scientific, Natick, Massachusetts, USA) was threaded into the fistula under fluoroscopic guidance (●" Fig.3). Colonoscopy was carried out simultaneously to visualize the guide wire’s exit point, which was emerging out of a field of diverticula in the sigmoid colon. The fistula was then flushedwith sterile water and a cytobrush (Cytomax II Double Lumen Cytology Brush, Wilson-Cook Medical, WinstonSalem, North Carolina, USA) was passed over the guide wire to denude the mucosa and promote closure. Lastly, both the proximal and distal ends of the fistula were closed with Resolution clips (Boston Scientific). The patient tolerated the procedure well. A repeat upper gastrointestiFig.1 Imaging findings in a 72-year-old man with a history of diverticulitis presenting with and fever and weight loss. a Barium imaging. b Computed tomography (CT) view. Fig.2 Endoscopic view showing the gastric fistula orifice on the greater curvature of the stomach.