# Combination of through-the-scope suturing and over-the-scope clips for closure of persistent gastrocutaneous fistula after gastrostomy tube removal (“X-lock technique”)

## TL;DR

A new endoscopic technique combining suturing and clips successfully closes persistent gastrocutaneous fistulas after gastrostomy tube removal.

## Contribution

The novel 'X-lock technique' combines through-the-scope suturing and over-the-scope clips for non-surgical closure of persistent GCF.

## Key findings

- Two patients with persistent GCF were successfully treated using the X-lock technique.
- No adverse events occurred, and both patients resumed oral intake the day after the procedure.
- One patient remained fistula-free for 2 months, and the other for over 12 months.

## Abstract

Persistent gastrocutaneous fistula (GCF) can occur after removal of gastrostomy tubes. Although surgical closure has historically been considered the most definitive treatment option, novel endoscopic devices have allowed for less-invasive closure techniques.

We present 2 cases in which closure of persistent GCF was performed using a combination of through-the-scope suturing and an over-the-scope clip (OTSC). In the first case, the suturing system and OTSC are used simultaneously, whereas in the second case, they are used sequentially.

There were no immediate postprocedural adverse events after both procedures. Both patients resumed oral intake the day after the procedure was performed. The first patient has had no leakage from previous GCF for 2 months, and the second patient has not had recurrent leakage for over 12 months since closure.

Combination of through-the-scope suturing and OTSC placement is a viable treatment option for chronic GCF after gastrostomy tube removal.