A 70-year-old female patient was undergoing oncological treatment for metastatic, inoperable adenocarcinoma of the antropyloric region of the stomach. Her clinical course was complicated by gastric perforation for which she underwent surgery. In the early postoperative period, the appearance of gastric fluid secretion through the skin sutures raised suspicion of a developing gastrocutaneous fistula. Gastroscopy revealed a fistulous opening at the proximal margin of the pyloric canal and a duodenal bulb stricture that was difficult to traverse, with normal-appearing mucosa distal to the stenosis. A 20×60 mm self-expanding metal duodenal stent (SEMS) was placed.

Because the stent did not adequately cover the fistulous opening and the fistula failed to close within a week, an uncommon but practical solution was chosen. Through the external fistula opening, a soft guidewire was introduced into the stomach, allowing placement of a thread for placing a percutaneous endoscopic gastrostomy (PEG) G-tube.

After PEG placement, the patient was given methylene-blue–colored tea to assess for leakage around the PEG insertion site. As no leakage occurred, she began full oral intake (initially enteral formulas and liquids only) and was subsequently discharged home in improved condition. Six months later, the PEG was removed and fistulous tract closed completely.

This case demonstrates how the endoscopist’s ingenuity and clinical experience can effectively manage a postoperative complication without the need for surgical intervention.