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.

Background/Objectives: Pancreatic metastases are uncommon and may resemble primary pancreatic neoplasms on imaging, making tissue confirmation essential. This study aimed to characterize pancreatic metastases diagnosed by endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) and to describe tissue adequacy within the confirmed cohort and procedure-related adverse events. Methods: This retrospective, single-center study included 21 patients with histologically confirmed pancreatic metastases diagnosed by EUS-FNB between January 2021 and November 2025. Clinical data, EUS features, procedural parameters, histopathological findings, management, and outcomes were reviewed. Results: The mean age was 60.9 ± 12.9 years, and 57.1% of patients were male. Lung carcinoma was the most frequent primary tumor (33.3%), followed by renal cell carcinoma (19.0%). Most lesions were solitary (66.7%) and hypoechoic (85.7%). All 21 patients included in the final cohort had histologically adequate EUS-FNB specimens; this finding reflects the selected cohort of confirmed metastatic cases and should not be interpreted as an overall adequacy rate or measure of diagnostic performance. The mean number of needle passes was 1.14 ± 0.36. One small, asymptomatic intrapancreatic hematoma occurred and resolved conservatively. Three selected patients underwent surgical resection and were alive without evidence of disease at last follow-up; however, no inference regarding a survival benefit from surgery can be made from this small, selected subgroup. Conclusions: In this cohort of histologically confirmed pancreatic metastases, EUS-FNB provided tissue suitable for pathological characterization, with immunohistochemical analysis performed when required to determine tumor origin. The present study was not designed to estimate overall diagnostic accuracy or adequacy. Surgical resection may be considered in carefully selected patients with isolated disease, as supported by the published literature; however, the present cohort does not permit assessment of a survival benefit associated with surgery.