Closing the Gap: Endoscopic Management of Post-Surgical Gastrointestinal Fistulas Using the Padlock Clip™—A Single-Center Experience

Background/Objectives: Post-surgical gastrointestinal fistulas represent severe complications associated with significant morbidity and therapeutic challenges. Over-the-scope clipping systems have expanded endoscopic management options; however, data regarding the Padlock Clip™ in mixed populations of acute and chronic fistulas remain limited. This study aimed to evaluate the feasibility, safety, and clinical outcomes of the Padlock Clip™ in the endoscopic management of post-surgical gastrointestinal fistulas in a tertiary referral center. Methods: We conducted a retrospective single-center study including 28 adult patients treated with the Padlock Clip™ between January 2021 and December 2025. Technical success, clinical success, reintervention rates, and adverse events were assessed. Exploratory subgroup analyses were performed according to surgical etiology and fistula complexity. Results: Technical success was achieved in 25/28 patients (89.3%), and clinical success occurred in 23/28 cases (82.1%). Reintervention was required in seven patients (25.0%). Adverse events occurred in three patients (10.7%) and were limited to clip migration. The median follow-up duration was 6.5 months (range 3–32 months). Sleeve gastrectomy-related fistulas demonstrated lower technical success compared with non-sleeve cases (72.7% vs. 100%). Immediate technical success was associated with a trend toward improved clinical outcomes. Complex fistulas showed lower healing rates and higher reintervention frequency. Conclusions: The Padlock Clip™ is a feasible and safe option for endoscopic management of post-surgical gastrointestinal fistulas. Immediate technical success appeared to be associated with improved clinical outcomes and may represent a potential factor in achieving durable fistula closure. Complex fistulas and sleeve gastrectomy-related defects may require multimodal therapeutic approaches.