Clinical Endoscopy

Gastric cancer presenting with ramucirumab-related gastrocolic fistula successfully managed by colonic stenting: a case report: Hiroki Fukuya, Yoichiro Iboshi, Masafumi Wada, Yorinobu Sumida, Naohiko Harada, Makoto Nakamuta, Hiroyuki Fujii, Eikichi Ihara; Clin Endosc 2023;56(6):812-816. Published online May 11, 2023; DOI: https://doi.org/10.5946/ce.2022.117

We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

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Ramucirumab

Reactions Weekly.2024; 1989(1): 189. CrossRef
Metastatic bladder cancer forming a sigmoidorectal fistula after enfortumab vedotin therapy: a case report
Shinji Tamada, Daiki Ikarashi, Naoki Yanagawa, Moe Toyoshima, Kenta Takahashi, Tomohiko Matsuura, Shigekatsu Maekawa, Renpei Kato, Mitsugu Kanehira, Ryo Takata, Wataru Obara
Frontiers in Oncology.2023;[Epub] CrossRef

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Percutaneous Endoscopic Gastrostomy Through the Sinus Tract of a Surgical Gastrostomy: Katerina Kotzampassi, George Stavrou; Clin Endosc 2015;48(1):78-80. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.78

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We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.

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Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique for patient safety
George Stavrou, Vassilios Grosomanidis, Anastasia Sarafidou, Gavriil Tsiropoulos, Stefanos Triaridis, Katerina Kotzampassi
American Journal of Otolaryngology.2020; 41(3): 102408. CrossRef

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A Case of a Pancreaticogastric Fistula Following Acute Pancreatitis: Jae Sung Youn, M.D., Hyeuk Park, M.D., Min Geun Lee, M.D., Woo Jong Kim, M.D., Jang Sik Mun, M.D., Bo Hyun Myoung, M.D., Do Hyun Kim, M.D. and Ho Dong Kim, M.D.; Korean J Gastrointest Endosc 2011;42(4):245-249. Published online April 28, 2011

Abstract PDF: A pancreatic fistula (PF) is an abnormal connection between the pancreas and adjacent or distant organs, structures, or spaces resulting from leakage of pancreatic secretions from disrupted pancreatic ducts. A PF is a rare complication that occurs during a acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. PFs are frequently classified as internal or external depending upon whether they communicate with an internal organ or the skin. Pancreatico-colonic fistulas are the most common, whereas pancreatico-gastric fistulas are the rarest. We report a rare case of a pancreatico-gastric fistula complicated by acute pancreatitis. (Korean J Gastrointest Endosc 2011;42:245-249)

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Primary Squamous Cell Carcinoma of the Gallbladder Forming a Cholecystogastric Fistula: Chang Jae Lee, M.D. and Jinsook Jung, M.D.*; Korean J Gastrointest Endosc 2010;40(4):285-289. Published online April 30, 2010

Abstract PDF: The most common type of gallbladder cancer is adenocarcinoma. Primary squamous cell carcinoma of the gallbladder is a rare and aggressive disease. It is responsible for up to 1.7% of the malignant neoplasms of the gallbladder. It characteristically presents with invasive growth, a low tendency towards lymph node metastasis and a high incidence of local infiltration and hepatic metastasis, presenting a worse prognosis than adenocarcinoma of the gallbladder. Cases of gallbladder cancer forming a fistula to the stomach are also rare. We experienced a case of primary squamous cell carcinoma of the gallbladder which formed a fistula to the stomach. (Korean J Gastrointest Endosc 2010;40:285-289)

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A Case of Gastrogastric Fistula as a Complication of Benign Gastric Ulcer: Sun Taek Choi, M.D., Jong Ryul Eun, M.D., Jung Hoon Lee, M.D., Yoon Seon Park, M.D., Jae Won Choi, M.D., Kook Hyun Kim, M.D., Byung Ik Jang, M.D., Tae Nyun Kim, M.D. and Heon Ju Lee, M.D.; Korean J Gastrointest Endosc 2006;33(6):364-367. Published online December 30, 2006

Abstract PDF: Gastrogastric fistula is an extremely rare complication of benign gastric ulcer. We report a case of gastrogastric fistula in a 67-year-old male who presented with symptoms of dyspnea on exertion, pretibial pitting edema, and dyspepsia. He suffered from a peptic ulcer 9 years ago and from a gastric outlet obstruction 5 years ago. A gastrogastric fistula was observed by endoscopy, and the biopsy forceps were passed through the fistulous tract. The patient was treated with proton pump inhibitors, and H. pylori was eradicated. Gastrogastric fistula, unlike other types of gastric fistulas, can be cured using non-surgical therapy as long as complications such as peritonitis, gastric outlet obstruction, and bleeding do not occur. (Korean J Gastrointest Endosc 2006;33:364⁣367)

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A Case of Pancreatogastric Fistula Associated with Intraductal Papillary Mucinous Neoplasm: Seung Geun Lee, M.D., Il Du Kim, M.D., Hye Jeong Lee, M.D., Tae Oh Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D., Jee Yeon Kim, M.D.* and Suk Kim, M.D.^†; Korean J Gastrointest Endosc 2006;33(4):257-260. Published online October 30, 2006

Abstract PDF: There have been an increasing number of reports of intraductal papillary mucinous neoplasm (IPMN) of the pancreas since its first report by Ohhasi et al. in 1982. However, fistula formation associated with IPMN to other organs is rare. A 79-year -old woman visited our hospital due to diarrhea and dyspepsia for 3 months. Abdominal computed tomography and magnetic resonance imaging revealed IPMN of the pancreas and fistula formation in the stomach. Endoscopic retrograde cholangiography after injecting a dye through the pancreatic duct showed dye flowing out into stomach. An endoscopic biopsy was carried out through the pancreatogastric fistula and this tumor was confirmed to be IPMN. We report a case of pancreatogastric fistula associated with IPMN that was confirmed by histology. (Korean J Gastrointest Endosc 2006;33:257⁣261)

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A Case of Liver Abscess Caused by Toothpick Penetrating Gastric Wall: Hyun Cheol Koo, M.D., Jae Pil Han, M.D., Ick Keun Kim, M.D., In Il Park, M.D., Jue Yong Lee, M.D., Kyung Min Sohn, M.D., Kwang Ho Baik, M.D., Jin Bong Kim, M.D. and Dong Jun Kim, M.D.; Korean J Gastrointest Endosc 2006;33(2):94-99. Published online August 30, 2006

Abstract PDF: The ingestion of foreign bodies into the gastrointestinal tract is common, and most are passed out spontaneously without causing any problems. However, a perforation can cause a variety of complications involving considerable morbidity and mortality. Moreover, clinical presentation of a perforation can vary and patients are often unaware of the episode. Hence, a pre-operative diagnosis is difficult under these circumstances. We report an unusual case of a liver abscess that developed secondary to a toothpick that had penetrated the gastric wall and migrated to the liver. The liver abscess was treated successfully with internal drainage by inserting an endoscopic pigtail catheter through the hepato-gastric fistula. The toothpick was removed using an endoscopic snare. (Korean J Gastrointest Endosc 2006;33:94⁣99)

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The Cholecystogastric Fistula and the Transmigration of the Gallstone: Sung Yeun Yang, M.D., Su Kyoung Kwon, M.D. and Ji Hwa Ryu, M.D.*; Korean J Gastrointest Endosc 2004;28(6):332-335. Published online June 30, 2004

Abstract PDF: The internal biliary fistula between the gallbladder or bile duct and intestinal tract is a rare disease. Because symptoms and signs of biliary fistula are not specific, these patients are commonly investigated with computed tomography, endoscopic retrograde cholangiopancreatography (ERCP) and barium study. Among them, a cholecystogastric fistula is a very rare type of biliary fistula. We recently experienced a case of cholecystogastric fistula and transmigration of the gallstone to the stomach. A 53-year- old woman was transferred with the impression of gallbladder cancer. On evaluating the cause of right upper abdominal pain and nausea, we confirmed the cholecystogastric fistula with gastroscopy, upper GI series and ERCP. Cholecystectomy and the repair of the fistula was done. (Korean J Gastrointest Endosc 2004;28:332⁣335)

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A Case of Gastrointestinal Stromal Tumor of the Stomach with a Gastric Fistula: Hee Joung Kim, M.D., Ho Sang Lee, M.D., Hyun Jong Oh, M.D., Chang-Whan Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):210-213. Published online April 30, 2003

Abstract PDF: Gastrointestinal stromal tumors (GIST) are mesenchymal gut tumors that lack markers of myogenic differentiation, but express CD34 and CD117, which are products of the c-kit oncogene. They present commonly gastrointestinal bleeding and abdominal pain and/or palpable mass. The other symptoms may include anorexia, weight loss, obstruction, perforation or fever. Fever due to abscess formation is rare complaint of GIST.
We report a case of GIST of stomach with abscess and gastric fistula in a 54-year-old male who presented a three-week history of abdominal pain and fever. Fistula opening site was observed by endoscope, and abdominal CT showed multiple air pockets within the mass representing communication with bowel lumen by fistula. (Korean J Gastrointest Endosc 2003;26:210⁣213)

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구연 / 담췌 : 58 세 남자 , 황달: Korean J Gastrointest Endosc 2001;22(5):321-322. Published online November 30, 2000

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무증상 좌측 간내 담도 - 위 누공 1 예: Korean J Gastrointest Endosc 2001;23(5):418-418. Published online November 30, 2000

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무증상 담낭 - 위 누공 1예 ( A Case of Asymptomatic Cholecystogastric Fistula ): Korean J Gastrointest Endosc 2000;20(4):322-326. Published online November 30, 1999

Abstract PDF: Biliary enteric fistulas which are caused by gallstone, peptic ulcer and carcinoma are an uncommon disease. Their incidence appears to increase recently with the advent of endoscopy. The usual types of the fistulas are choledochoduodenal, cholecystoduodenal and cholecystocolonic. But, cholecystogastric fistulas are very rare. Their symptoms are usually nonspecific and pneumobilia has been considered as a clue, but the diagnosis is difficult in most cases. At present, endoscopy is very helpful to the diagnosis. The treatment of asymptomatic fistulas is still in dispute. Endoscopic management is being used at times in recent days. We recently experienced a case of cholecystogastric fistula accidentally. During the evaluation for the cause of anemia, we suspected a fistula on endoscopy and confirmed it on endoscopic fistulography and managed it by endoscopic papillotomy and stone extraction. (Korean J Gastrointest Endosc 2000;20:322-326)

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