Esophago-bronchial fistula treated by the Over-The-Scope-Clipping (OTSC) system with argon beam electrocoagulation

Abstract

Rationale: An esophago-bronchial fistula is one of the rare postoperative complications of esophageal cancer. There are various medical treatments, including suturing, endoscopic clip, and fibrin glue. However, these treatments often lead to unsatisfactory results, causing physicians to opt for surgical alternatives. The Over-The-Scope-Clipping (OTSC) system offers an alternative method for fistula closure. It can capture a large amount of tissue and is able to compress the lesion until it has fully healed. However, data indicating the efficacy of OTSC for esophago-bronchial fistula are limited. Patient concerns: A 64-year-old man presented with an esophago-bronchial fistula after surgery for esophageal cancer. We chose to use a stent as the first line of treatment, but the fistula did not close. Diagnoses: Intractable esophago-bronchial fistula associated with esophageal surgery. Interventions and Outcomes: On the 94th postoperative day, fistula closure with OTSC was performed, and no leakage of the contrast agent was observed during fluoroscopy. We also attempted to close the fistula by combining OTSC and argon plasma coagulation (APC) to burn off the scar tissue from around the fistula. The fistula gradually shrank after a total of 4 rounds of OTSC, and closure of the fistula was achieved on the 185th postoperative day. There were no adverse events during the treatment of this case. Lessons: We demonstrate that OTSC is useful in the management of esophago-bronchial fistulas, and may become a standard procedure for the endoscopic treatment of esophago-bronchial fistulas, replacing the use of stents, clips, or glue.

Fistula Closure Using a Vastus Lateralis Skin Valve for Esophagobronchial Fistula Occurring During Preoperative Chemotherapy for Lung Cancer: A Case Report

“…Nevertheless, there is currently no established treatment plan for this condition. In general, esophagobronchial fistulas can be treated using surgical stenting, esophagectomy, esophageal bypass, and myocutaneous valve surgery; recently, self-expandable plastic stents such as the over-the-scope clip have also been used [ 2 , 6 ]. However, indications for such procedures are still largely based on experience [ 7 ].…”

“…In such instances, digestive fluids may enter the bronchus and lungs, causing respiratory symptoms. Although no standardized treatment is available for this disease, placement of esophageal or tracheal stents and endoscopic clipping may be considered [ 1 , 2 ]. Nevertheless, esophagobronchial fistulas are often refractory.…”

Adequate Management of Postoperative Complications after Esophagectomy: A Cornerstone for a Positive Outcome

“…A systematic review published in 2018 on the management of ERF after esophagectomy highlighted that while non-surgical managements are feasible and easy, they are usually associated with a higher failure rate when compared to the definitive surgical treatment [ 111 ]. Due to the fibrotic nature of fistula edges, a treatment with OTSC ® usually fails [ 112 ].…”

Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review

“…If a patient’s general condition is good, we may perform the second and third procedure at the same time. In recent years, successful cases of endoscopic fistula closure have been reported [ 23 , 24 ], and this may become a treatment option. However, we did not choose endoscopic treatment in our case because we were concerned that aspiration pneumonia and respiratory failure due to the EBF would be exacerbated by endoscopic insufflation.…”