Duodenocolonic fistula is a rare complication of both benign and malignant GI disease that can result in severe diarrhea and weight loss. Surgical fistula closure has historically been the conventional treatment option. In this case, we present successful endoscopic closure of a duodenocolonic fistula using a self-expanding nitinol wire mesh device. A 63-year-old woman with metastatic neuroendocrine tumor presented with severe diarrhea and a 15-kilogram weight loss. A percutaneous transhepatic biliary drain, an internal biliary stand, and a percutaneous endoscopic gastrostomy tube with jejunal extension had been placed previously. Biliary drain check revealed a fistula-less connection from the duodenum to the colon at the level of the hepatic flexure. On upper endoscopy, a 5-millimeter fistula-less opening was found in the second portion of the duodenum, visualized here at 10 o'clock. A guide wire was advanced through the PEG-J tube into the jejunum, and the PEG-J tube was removed afterwards. A second guide wire, shown here at the red arrow, was advanced through the fistula-less connection into the right colon. A delivery catheter was advanced over the guide wire into the right colon. The guide wire was then removed, and a self-expanding nitinol wire mesh device was advanced through the delivery catheter and deployed in the fistula-less tract. This was done by deploying the distal flange inside the right colon, applying gentle traction, and slowly pulling back the delivery catheter, resulting in deployment of the nitinol wire mesh device inside the fistula-less tract. Here is the endoscopic view of the proximal flange of the wire mesh device. Next, an 18-millimeter by 10-centimeter partially covered distal release ultraflex stent was advanced over the initial guide wire and deployed into the duodenum. Contrast injection in the proximal duodenum confirmed no further contrast leakage into the right colon at the conclusion of the procedure. In summary, duodenocolonic fistulas are rare complications that can arise secondary to both benign and malignant gastrointestinal disease. Diarrhea is the most prominent symptom, and treatment typically consists of surgical closure. In this case, we described a successful closure of a malignant duodenocolonic fistula using a vascular self-expanding nitinol wire mesh device to occlude the entire fistula-less tract.

duodenocolonic fistula

endoscopic closure

neuroendocrine tumor

nitinol wire mesh

minimally invasive