Treatment of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Using Endoscopic Suturing With Argon Plasma Coagulation: A Report of Two Cases

Persistent gastrocutaneous fistula (PGCF) is an uncommon but often challenging complication following removal of a percutaneous endoscopic gastrostomy (PEG) tube. Prolonged PEG tube requirement leads to epithelialization of the PEG tube tract, resulting in a PGCF when the tube is removed. Several management options have been described for this complication, many of which demonstrate variable success rates. However, no definitive treatment for PGCF has been established. We report two adult male patients, aged 63 and 30 years, who developed PGCF after PEG tube removal following prolonged PEG placement. The first patient had persistent low-volume drainage for approximately one year after removal of the PEG tube, despite an attempt at external purse-string suture closure with simultaneous endoscopic clip placement. The second patient developed persistent high-volume drainage with peristomal skin breakdown despite local wound care and ostomy appliance placement for 3 months after removal of the PEG tube. Both patients underwent argon plasma coagulation of the fistula tract followed by endoscopic suture closure using the Boston Scientific OverStitch device (Boston Scientific Corporation, Marlborough, USA). In both cases, fistula drainage resolved within one week, with no documented recurrence during available follow-up. These cases are reported to highlight the technical feasibility of combined argon plasma coagulation and endoscopic suturing for selected chronic post-PEG PGCFs and to add to the limited published experience with this approach