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Endoscopic drainage of fistulas with plastic stents after bariatric surgery is a minimally invasive technique with high success and low morbidity rates [1, 2]. However, it is sometimes difficult to find or cannulate the internal orifice of the fistula owing to limited maneuverability, a relatively small opening, tortuous trajectory or even spontaneous closure of the orifice. In such cases, endoscopic ultrasound (EUS)-guided puncture can be an option for draining various fluid collections in the abdominal cavity [3, 4], by finding the internal orifice or by creating an additional trajectory to the collection [5]. We report the case of a 38-year-old patient with a postbariatric gastro-cutaneous fistula who was referred to our department for endoscopic drainage. Despite conservative therapy 3 months after a sleeve gastrectomy, the patient experienced continuous purulent cutaneous discharge of a peri-gastric collection. Water-soluble contrast swallow computed tomography (CT) scan showed a gastro-cutaneous fistula originating at the upper part of the staple line of the sleeve gastrectomy (▶Fig. 1 a). During the first endoscopy attempt, the gastric orifice was not visible despite injection of contrast via the cutaneous orifice. A second endoscopy was attempted and the fistula tract was detected endosonographically by injecting solution into the fistula through the cutaneous E-Videos

Endoscopic ultrasound-guided detection and internal drainage of a closed gastro-cutaneous fistula after bariatric surgery