Successful endoscopic closure of a refractory button-battery tracheoesophageal fistula in a 3-year child using endoscopic submucosal dissection of the surrounding mucosa

Abstract

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.

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

“…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.…”

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

“…1 and ▶ Fig. 2, ▶ Video 1) centered on the fistula, as previously described [2]. The patient underwent tracheal intubation with balloon placement just under the fistula.…”

Endoscopic submucosal dissection combined with clip for closure of gastrointestinal fistulas including those refractory to previous therapy

“…Nevertheless, large studies evaluating those methods are lacking and long-term resolution of chronic fistulas was obtained in less than 50% of cases [8,9]. Therefore, as previously proposed in case reports [10][11][12][13][14][15], we combined two approaches with both Endoscopic submucosal dissection (ESD) of the surrounding mucosa in order to promote healing combined with clip closure into the submucosal space to increase the chances of tight healing (Figure 1).…”