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Most serious button-battery ingestions are not witnessed and they can cause life threatening complications. We present here the case of a 3-year-old girl who swallowed a button battery in January 2016 with a delayed diagnosis being made after 10 days. A 5-mm tracheoesophageal fistula was endoscopically diagnosed (▶ Fig. 1). The first attempts at closure involved the deployment of two successive esophageal covered stents between January and May (▶ Fig. 2). The fistula decreased in size but persisted, so we then attempted controlled wound healing with a nasogastric tube, but the fistula still remained. Next, we tried a side fistula abrasion with argon plasma coagulation. Unfortunately, these techniques did not allow full recovery, even though the fistula reduced notably. After 1 year, we tried endoscopic submucosal dissection (ESD) of the mucosa surrounding the fistula, resecting a 1-cm mucosal patch centered on the fistula. After injecting the submucosa and making the mucosal incision, we used a Dual-Knife (Olympus) to dissect the fibrotic area. After the dissection, the fistula was closed with three clips anchored into the submucosa of the resected area (▶ Fig. 3; ▶ Video 1). We arranged a radiologic check with contrast, which Video 1 Views of the fistula and previous attempts to close it. The endoscopic submucosal dissection procedure is performed to resect the surrounding mucosa, which is subsequently clipped to close the fistula. ▶ Fig. 1 Appearance of the tracheoesophageal fistula in a 3-year-old girl after ingestion of a button battery. ▶ Fig. 2 Radiographic images showing: a the fistula on a barium swallow; b the first attempted closure procedure with a stent positioned in the esophagus.

Control of ossicular prosthesis positioning via the PT does not improve hearing results after ossicular chain reconstruction in cholesteatoma surgery. However, this approach can be used during a second-stage procedure that avoids incisions within the external ear canal.