With an Over-the-Scope Clip

Bleeding peptic ulcer is a life threatening condition with high mortality rate but often treatable by endoscopy. Surgical indications in case of gastroduodenal ulcers are confined to endoscopic and radiological failures in bleeding control. Duodenal fistula (DF) is a rare complication of gastric resection and even if a rare event it may be a life threatening condition. Surgical and medical options could not solve the DF. Herein we report a case of an old patient underwent emergency gastrectomy for ulcer’s bleeding who developed DF associated to sepsis, malnutrition and, hydro-electrolyte disorders not responding to surgical and medical attempts. We demonstrated, for the first time, the efficacy of over the scope clips (OTSC®) in the treatment of postoperative duodenal fistulas not responding to surgical and medical treatment in high risk patient. Keywords flexible endoscopy, gastric surgery, surgical education Duodenal fistula (DF) is a rare complication of gastric resection (GR) for bleeding ulcer. Even if a rare event, DF continues to be a life-threatening problem leading to intra-abdominal abscess, peritonitis, sepsis, malnutrition, fluid and electrolyte disturbances, and others. Mortality ranges from 7 % to 60%. When systemic complications occur, surgery is needed but it does not always succeed. In this report we describe, for the first time, the successful use of an Over-the-Scope Clip (OTSC; Ovesco Endos-copy GmbH, Tubingen, Germany) to close DF occurred after GR. Case Report We report the case of a 78-year-old man with a history of atrial fibrillation, congestive heart failure, laryngeal neo-plasm, who was admitted to our emergency department for pyloric bleeding ulcers, nonresponding to endoscopi