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Crohn's disease is associated with many intestinal complications, such as stenosis and fistula, and many cases require intestinal resection during the course of the disease. Although anti-tumor necrosis factor α (TNFα) agents are effective in inducing remission of active Crohn's disease, they are ineffective for certain intestinal complications, such as fistulas [1]. We attempted endoscopic closure for a patient in whom anti-TNFα agents were not effective in treating the fistula. The patient was a 52-year-old man with ilealand colonic-type Crohn's disease who was receiving maintenance treatment with infliximab. He had been experiencing sudden bowel movements and watery stool for several years owing to a cecal–sigmoid fistula that had not closed with infliximab treatment. Colonoscopy revealed a cecal–sigmoid fistula that allowed a 10.8-mm endoscope to be passed through it (▶Fig. 1). We obtained informed consent from the patient and attempted endoscopic closure of this fistula (▶Fig. 2; ▶Video 1). An endoscopic purse-string suture with a nylon loop and clips was placed using a two-channel scope. Although complete closure was not achieved, the fistula E-Videos

The challenge of fistula closure in Crohn's disease: an endoscopic technique for closure of a fistula