Closure of pancreatic intraductal papillary mucinous carcinoma-colonic fistula using an over-the-scope clip.

Pancreatic intraductal papillary mucinous carcinoma (IPMC) can rupture and lead to fistula formation in multiple organs [1,2]. An over-the-scope clip (OTSC) has been used to close gastrointestinal perforations and fistulas [3]. We describe a patient in whom the OTSC was useful for the closure of an IPMC-colonic fistula accompanied by infection. The patient was a 57-year-old woman who was transferred to another hospital because of acute abdomen. Rupture of an IPMC of the pancreatic tail caused by pancreatic body cancer and splenic abscess were diagnosed. Even if surgery was performed, curative resection was impossible, and peritoneal drainage and splenectomy were thus performed. The patient was referred to our hospital. Chemotherapy was begun, but a second rupture occurred 2months after the initial rupture. The patient’s condition responded to medical treatment, and chemotherapy was resumed. A high fever and high levels of inflammatory markers were noted 4 months after the initial rupture. Contrast-enhanced computed tomography suggested fistula formation in the stomach and transverse colon (●" Fig.1). Upper endoscopywas performed. The fistula site was dilated and the endoscope was inserted. Type 3 and 4 papillary nodules [4] were seen (●" Fig.2, ●" Fig.3, ●" Video1). Biopsy revealed adenocarcinoma. Colonoscopy showed mucus outflow and type 3 papillary nodules in the splenic flexure. Infectious IPMC caused by fecal influx was highly suspected. The infection improved after fasting and treatment with antibiotics. Then, the OTSC system (Ovesco Endoscopy AG; Tübingen, Germany) was used to close the IPMCcolonic fistula (●" Video 2). Infection did not recur before the patient died of cancer. In addition, there was no recurrence of rupture associated with closure of the IPMC-colonic fistula. Fistula closure with an OTSC can be a treatment option for unresectable and infectious IPMC-colonic fistulas.