ASGE DDW Videos from Around the World | 2026-ENDOSCOPIC CLOSURE OF GASTROPERICARDIAL FISTULA WITH ACTIVE PERICARDIAL DECOMPRESSION TO PREVENT TAMPONADE

ENDOSCOPIC CLOSURE OF GASTROPERICARDIAL FISTULA WITH ACTIVE PERICARDIAL DECOMPRESSION TO PREVENT TAMPONADE

Video Transcription

Video Summary

An 84-year-old woman developed a rare gastropericardial fistula after prior chest radiation, likely from a gastric ulcer/hiatal hernia complication. She presented in shock with severe anemia, pneumopericardium, and suspected tamponade. Because she was too unstable for surgery, a multidisciplinary team placed a pericardial drain before endoscopy. During CO2 insufflation, tamponade occurred but was relieved by opening the drain. The fistula was then closed endoscopically with OverStitch suturing, and success was confirmed with a water-seal test. The case highlights pericardial decompression as a critical safeguard during endoscopic repair.

Asset Subtitle

Endoscopy in Action
Submitted by Shuji Mitsuhashi

Keywords

gastropericardial fistula

pericardial drain

endoscopic OverStitch repair

pneumopericardium

tamponade