Deep endoscopic submucosal dissection of a refractory tracheoesophageal fistula using clip-and-line traction: a successful closure

Bertrand, G; Jacques, J.; Rivory, Jérôme; Rostain, Florian; Saurin, Jean‐Christophe; Ponchon, Thierry; Pioche, Mathieu

doi:10.1055/s-0043-119348

Cited by 16 publications

(12 citation statements)

References 5 publications

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“…Because the recommended management of ERF relies on esophageal stents 7 , we only included patients with chronic non-malignant ERF refractory to initial management with conventional stents. Thus, we selected cases with well-organized, fibrotic, large fistulas for which clipping, either directly during or after submucosal dissection 8 was not possible. Indeed, the stability of the device requires a regular-shaped and large fistula.…”

Section: Discussionmentioning

confidence: 99%

Amplatzer occluders for refractory esophago-respiratory fistulas: a case series

et al. 2021

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Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.

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Section: Discussionmentioning

confidence: 99%

Amplatzer occluders for refractory esophago-respiratory fistulas: a case series

et al. 2021

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“…There is no generally recommended approach to endoscopic closure of gastrointestinal fistulas. Although the OTSC system is becoming widely used in this setting, in the setting of chronic fistulas, long-term clinical success occurs in only about one-third of patients [2], and previous dissection of the fistula may enhance tissue scarring, as previously demonstrated in esophagotracheal fistulas [3,4]. To summarize, ESD of a fistulous orifice can be a valuable additional tool that may increase the success rates of endoscopic fistula closure using the OTSC system.…”

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confidence: 92%

Successful closure of a refractory rectal anastomotic fistula using endoscopic submucosal dissection combined with an over-the-scope clip

et al. 2018

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Video 1 Endoscopic submucosal dissection of a patch of mucosa surrounding the fistulous orifice followed by over-the-scope clip (OTSC) closure.▶ Fig. 3 Endoscopic submucosal dissection of the mucosal area around fistulous orifice before clip closure. Endoscopic appearance: a of the fistulous orifice; b following submucosal injection; c after mucosal incision; d of the perifistulous mucosal defect after dissection and cold forceps avulsion. E100Barsic Neven et al. ESD with OTSC for refractory rectal anastomotic fistula … Endoscopy 2018; 50: E99-E101

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“…éTo close the fistula, we combined circumferential endoscopic submucosal dissection (ESD) of the surrounding mucosa and over-the-scope clipping of the fistula tract as previously reported (▶ Fig. 2) [2][3][4]. Two hemoclips were additionally placed on the colonic side.…”

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confidence: 99%