Abstract An esophagorespiratory fistula (ERF) is a rare but potential complication of surgical interventions aimed at treating esophageal and bronchogenic carcinomas. Endoscopic surgical repair of these fistulas is rare and highly complex due to the overall mortality. We present a case of endoscopic closure of an ERF. A 58 year-old male presented with progressive worsening dysphagia with an associated 15 pounds weight loss over 3 weeks. He was found to have a well-differentiated esophageal adenocarcinoma in the lower third which was removed via an Ivor-Lewis procedure with a jejunostomy tube placed for enteral feeding 1.5 years prior to presentation. His post-surgical course was complicated by persistent aspiration events, caused by an anastomotic leak. Esophageal stents and clips were placed post-surgically every 2 months due to a persistent non-healing fistula. A bronchoscopy showed a fistula in the right bronchus at the entrance of the right main stem with a visible esophageal stent. The bronchoscope was left in place and an esophagogastroduodenoscope placed in the esophagus which found a 2x2 cm fistula at 25-28 cm from the incisors. The stent was removed, and argon plasma coagulation laser and edge brushing were performed at the edges of either side of the fistula. An Apollo Boston Scientific overstitch device was attached to the dual channel therapeutic endoscope with two interrupted running sutures and one intermittent suture being placed. The sutures showed good approximation; however, bubbles were seen in the esophageal lumen which resolved with another intermittent suture. Two Mantis Boston Scientific clips were placed to support the approximation. Bubbles were no longer visible on either side of the defect. VistaSeal was topically applied on both sides over the repaired area for additional support. Immediate post-procedural and outpatient contrast-enhanced imaging continues to show no leak between the esophagus and bronchus. Esophagorespiratory fistulas are a rare complication usually associated with surgery, infection, or malignancy, with a high rate of mortality due to subsequent malnutrition and sepsis. Esophageal stents are usually first line to mitigate aspiration events. Endoscopic suturing has been used more often in benign tracheoesophageal fistulas. However, our patient did not improve despite frequent esophageal stent placement. He eventually required endoscopic intervention with multiple techniques such as reepithelization, suture approximation, endoscopic clipping, and topical fibrin application. His repeat imaging studies showed continued successful closure of the fistula. To our knowledge, this is the only case in literature with a stepwise multimodal approach to esophagorespiratory fistula closure. This abstract is funded by: none
Liu et al. (Fri,) studied this question.