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A 43-year-old woman was referred to our department owing to uncontained duodenal leak, drained from the retroperitoneal space (> 500mL/24h) (▶Fig. 1). Her medical history was significant for laparoscopic right nephrectomy owing to calculous pyonephrosis 7 days earlier. The patient refused surgery; thus, endoscopic intervention was performed (▶Video1). Upper endoscopy confirmed the presence of the fistula at the junction of the duodenal bulb and descending duodenum (▶Fig. 2 a). Successful closure of the defect was achieved using a pursestring suture after failed attempts with endoclips (▶Fig. 2b). We then carried out double percutaneous endoscopic gastrostomies (PEG) (▶Fig. 2 c). One PEG with placement of a jejunal feeding tube was for enteral nutrition, whereas the other was connected to the negative pressure drainage bag for gastric decompression and drainage. A nasointestinal decompression tube with string attached was placed near the fistula and fixed using an endoclip, for duodenal drainage. Conservative treatments were continued. The output from the retroperitoneal drainage tube reduced gradually, and no liquid was noted after 1 month. A gastrointestinal contrast study demonstrated no leaks (▶Fig. 3). Repeat upper endoscopy also showed the healing of the duoE-Videos

Purse-string suture and double percutaneous endoscopic gastrostomies for treating a postoperative duodenal fistula