Therapeutic endoscopy plays a critical role in the management of gastrointestinal (GI) fistulas. Innovative endoscopic approaches have revolutionized the treatment of GI fistulas; however, current endoscopic treatment modalities require multiple sessions and are associated with highly variable success rates and safety profi les. Due to these currently limitations, the off -label use of cardiac septal defect occluders (CSDOs) has emerged as a promising device to treatment GI fi stulas, with early studies suggesting it to be a technically feasible, effective, and safe treatment. Therefore, we believe CSDO devices may be a preferred option for the management of refractory GI fistulas.