Pancreatic pseudocyst with complicating colonic fistula successfully closed using the over-the-scope-clip system.

A 53-year-old man had a history of alcohol-induced chronic pancreatitis. In July 2011, because of suspicion of a pseudocyst infection, he had undergone endoscopic ultrasound (EUS)-guided cyst drainage. Further investigation after drainage had revealed a fistula between the pancreatic pseudocyst and descending colon; however, the transgastric internal drainage tubewas left in place because of the severity of the patient’s condition. In August 2013, the patient visited our institution again and on the basis of an abdominal computed tomography (CT) examination, itwas suspected that the fistula between the pancreatic pseudocyst and colon had persisted and was re-infected (●" Fig.1). The transgastric internal drainage tube that had been inserted during his previous hospitalization was found to be obstructed (●" Fig.2). Although the general health of the patient had improved, the fistula between the pancreatic pseudocyst and colon was still present (●" Fig.3). This fistulawas believed to have caused repeated cyst infections. Therefore, using lower gastrointestinal endoscopy, the location of the fistula in the descending colon was confirmed (●" Fig.4) and the fistula was closed using the over-the-scope clip (OTSC) system (Ovesco Endoscopy AG, Tübingen, Germany) (●" Fig.5). Thereafter, fistula closure was confirmed by radiographic imaging of the transnasal catheter that had been inserted (●" Fig.6). At the Fig.1 Abdominal computed tomography (CT) examination revealed obstruction of the main pancreatic duct in the pancreatic tail, and formation of a pseudocyst caudal to this obstruction. The wall of the pseudocyst was thickened, and air bubbles were observed inside the cyst, indicating infection of the cyst (arrow). A section of the border with the descending colon (arrowhead) was obscured, and therefore, the presence of a fistula was suspected.