Combined Endoscopic Fistulotomy and Clipping for the Treatment of Fistula From the Tip of the J-Pouch to Anastomosis

Patients who undergo restorative protocolectomy with ileal pouch-anal anastomosis may develop mechanical complications such as presacral sinuses and fistulas. The current method of treatment may include medical therapy or redo surgery. Recently, endoscopic management for postoperative complications has shown effective results. We present a unique case of a pouch-to-pouch fistula, from the tip of the "J" to the anastomosis that was successfully treated with endoscopic needle-knife sinusotomy and over-the-scope clips.