Novel Use of an Endoscopic Suturing Device to Repair a Cholecystoduodenal Fistula

A 50-year-old woman with a history of uncomplicated Crohn’s disease presented for esophagogastroduodenoscopy (EGD) for evaluation of acute epigastric pain, nausea, and bilious vomiting. EGD revealed retained food in the stomach and what appeared to be a large, approximately 2-cm obstructing gallstone in the duodenal bulb (Figure 1). After multiple instruments failed to retrieve the gallstone, a needle knife was utilized to break the gallstone into pieces that were then retrieved using a Roth net. After removal of the gallstone, a suspected cholecystoduodenal fistula was seen. An emergent computed tomography of the abdomen confirmed a fistulous tract between the gallbladder and duodenum (Figure 2). Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated contrast extravasating from the gallbladder into the duodenum. Biliary sphincterotomy was performed with the placement of a 10 Fr x 5 cm plastic biliary stent in the common bile duct. An additional stone that was impacted within the cholecystoduodenal fistula was removed successfully using a stone-extracting balloon (Figure 3). An endoscopic suturing device was utilized to place one endoscopic suture, resulting in complete closure of the fistula (Figure 4). The patient subsequently underwent uncomplicated, open cholecystectomy with no fistula seen during surgery.