Novel Closure Technique With Double-Balloon Endoscopy-Guided Embolization by Gelatin Sponge and Clip Suturing for Postoperative Enterocutaneous Fistula With Bile Leakage.

A 60-year-old female with abdominal pain and nausea was diagnosed with gallbladder cancer (cT3aN2M1, cStage IVB). Distant metastases had disappeared after 10 courses of chemotherapy, followed by conversion surgery consisting of subtotal stomach-preserving pancreaticoduodenectomy, partial hepatectomy, and dissection of para-aortic and regional lymph nodes. On postoperative day (POD) 3, additional drainage was performed from the median incision because of bile leakage (BL) from the choledochojejunostomy. The drain tube was removed on POD 89, and the patient was discharged. On the 13th day after discharge, BL was found from the median incision. Double-balloon endoscopy-guided endoscopic retrograde cholangiopancreatography was performed to investigate the cause of BL and decompress the bile duct. Although cholangiography revealed no obvious injury of the bile duct, endoscopic examination discovered a fistulous opening near the choledochojejunostomy, which was revealed to be the responsible lesion of the enterocutaneous fistula by contrast imaging. Closure of the enterocutaneous fistula was performed with a combination of embolization by gelatin sponge and endoscopic clip suturing. Rapid fistula closure was achieved after the procedure, and the patient was discharged without complications. This treatment method is considered a minimally invasive and effective therapeutic option for BL associated with postoperative enterocutaneous fistulas.