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Peer-reviewedCC BYVideoGIE

Use of through-the-scope suturing for peripancreatic-colonic fistula closure via a lumen-apposing metal stent

  • Mufaddal Jafferjee, DO1
  • Ashmita Gautam, MD2
  • Melvin Simien, MD3
  1. 1Department of Internal Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA; Corresponding author: Mufaddal Jafferjee, DO, Department of Internal Medicine Baylor Scott & White All Saints Medical Center Fort Worth, Fort Worth, 2133 Layla Dr, Waxahachie, Texas, USA.
  2. 2Department of Internal Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA
  3. 3Department of Gastroenterology, Baylor Scott & White Digestive Diseases, Fort Worth, Texas, USA
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Abstract

Background and Aims: Peripancreatic-colonic fistulas (PCFs) are rare but serious adverse events of necrotizing pancreatitis and can lead to persistent infection and feculent contamination. Surgical management is often high risk in critically ill patients. We describe successful endoscopic closure of a PCF using a through-the-scope helical tack suturing system (X-Tack; Boston Scientific, Marlborough, Mass, USA) via a lumen-apposing metal stent tract. Methods: A 45-year-old woman with necrotizing pancreatitis and walled-off necrosis underwent endoscopic drainage using a 20- × 10-mm lumen-apposing metal stent (LAMS). During serial necrosectomies, a fistulous tract connecting the necrotic cavity to the colon near the splenic flexure was identified. After argon plasma coagulation (APC) was applied to the defect margins, closure was attempted with an endoscopic suturing device (OverStitch NXT; Boston Scientific) but was technically limited due to access constraints. A through-the-scope (TTS) helical tack suturing system was then deployed through the LAMS to approximate the defect. Results: The TTS system allowed successful defect closure through the existing transmural tract. Follow-up imaging and colonoscopy confirmed durable closure without recurrence. Conclusions: This case demonstrates that TTS suturing via a LAMS tract is technically feasible and may provide a minimally invasive option for management of PCFs in selected patients.

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Cite

BibTeXRIS
BibTeX
@article{mufaddaljafferjee2026throughthescope,
  title = {{Use of through-the-scope suturing for peripancreatic-colonic fistula closure via a lumen-apposing metal stent}},
  author = {Mufaddal Jafferjee, DO and Ashmita Gautam, MD and Melvin Simien, MD},
  journal = {VideoGIE},
  year = {2026},
  month = nov,
  doi = {10.1016/j.vgie.2026.04.006},
  url = {https://doi.org/10.1016/j.vgie.2026.04.006},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Use of through-the-scope suturing for peripancreatic-colonic fistula closure via a lumen-apposing metal stent
AU  - Mufaddal Jafferjee, DO
AU  - Ashmita Gautam, MD
AU  - Melvin Simien, MD
PY  - 2026
DA  - 2026/11/08
JO  - VideoGIE
DO  - 10.1016/j.vgie.2026.04.006
UR  - https://doi.org/10.1016/j.vgie.2026.04.006
AB  - Background and Aims: Peripancreatic-colonic fistulas (PCFs) are rare but serious adverse events of necrotizing pancreatitis and can lead to persistent infection and feculent contamination. Surgical management is often high risk in critically ill patients. We describe successful endoscopic closure of a PCF using a through-the-scope helical tack suturing system (X-Tack; Boston Scientific, Marlborough, Mass, USA) via a lumen-apposing metal stent tract. Methods: A 45-year-old woman with necrotizing pancreatitis and walled-off necrosis underwent endoscopic drainage using a 20- × 10-mm lumen-apposing metal stent (LAMS). During serial necrosectomies, a fistulous tract connecting the necrotic cavity to the colon near the splenic flexure was identified. After argon plasma coagulation (APC) was applied to the defect margins, closure was attempted with an endoscopic suturing device (OverStitch NXT; Boston Scientific) but was technically limited due to access constraints. A through-the-scope (TTS) helical tack suturing system was then deployed through the LAMS to approximate the defect. Results: The TTS system allowed successful defect closure through the existing transmural tract. Follow-up imaging and colonoscopy confirmed durable closure without recurrence. Conclusions: This case demonstrates that TTS suturing via a LAMS tract is technically feasible and may provide a minimally invasive option for management of PCFs in selected patients.
SN  - 2468-4481
ER  -