{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:04:32Z","timestamp":1762430672102,"version":"3.40.4"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Widening of the exit site of a percutaneous gastrostomy tube is a rare but difficult to manage complication, which leads to significant morbidity as a result of caustic material leak and associated cutaneous injury. Such defects fail to close with conservative measures such that invasive (surgical or endoscopic) intervention is often required. The authors present a 49-year-old woman with neurological dysphagia, 2\u2005years after gastrostomy tube insertion with several months\u2019 history of leakage and widening of the hole at the exit site. Following gastrostomy tube removal; the patient was left with a large, high-output gastrocutaneous fistula which was treated aggressively with measures to reduce gastric discharge including \u2018nil-by-mouth\u2019, bypassing the stomach with distal feeding, administration of a somatostatin analogue, high-dose proton pump inhibitor and prokinetics with the aim of preoperatively downsizing the wound. This novel approach led to complete closure of the large gastrocutaneous fistula, obviating the need for surgical intervention.<\/jats:p>","DOI":"10.1136\/bcr-2012-007267","type":"journal-article","created":{"date-parts":[[2012,10,23]],"date-time":"2012-10-23T16:36:23Z","timestamp":1351010183000},"page":"bcr2012007267","source":"Crossref","is-referenced-by-count":11,"title":["Closure of a large high-output gastrocutaneous fistula with combined postpyloric feeding and aggressive medical therapy"],"prefix":"10.1136","volume":"2012","author":[{"given":"Dipesh Harshvadan","family":"Vasant","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Lal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda D","family":"Blackett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A","family":"Paine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2012,10,23]]},"reference":[{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.1","doi-asserted-by":"crossref","first-page":"686803","DOI":"10.5402\/2011\/686803","article-title":"Incidence and predictors of gastrocutaneous fistula in the pediatric patient","volume":"2011","author":"Bratu","year":"2011","journal-title":"ISRN Gastroenterol"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(99)90008-8"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.05.002"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.4","doi-asserted-by":"crossref","first-page":"384143","DOI":"10.1155\/2011\/384143","article-title":"Endoscopic treatment of a gastrocutaneous fistula using the over-the-scope-clip system: a case report","volume":"2011","author":"Kouklakis","year":"2011","journal-title":"Diagn Ther Endosc"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2011.04.031"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(02)70133-8"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.7","doi-asserted-by":"publisher","DOI":"10.1177\/0884533608314535"},{"issue":"1","key":"2025042707235094000_2012.oct22_1.bcr2012007267.8","first-page":"83","article-title":"Treatment of high-output gastric fistulas with omeprazole","volume":"38","author":"Deruyter","year":"1991","journal-title":"Hepatogastroenterology"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(05)70507-7"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.10","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-200010000-00003"},{"key":"2025042707235094000_2012.oct22_1.bcr2012007267.11","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e32834a345d"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2012-007267","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T14:24:01Z","timestamp":1745763841000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2012-007267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,10,23]]},"references-count":11,"alternative-id":["10.1136\/bcr-2012-007267"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2012-007267","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2012,10,23]]}}}