Gastro-bronchial fistula closed by endoscopic fistula plug (with video)
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- 作者：Ahmed Sharata (1) (2)
Neil H. Bhayani (1)
Christy M. Dunst (2)
Ashwin A. Kurian (1)
Kevin M. Reavis (2)
Lee L. Swanstr?m (2) - 刊名：Surgical Endoscopy
- 出版年：2014
- 出版时间：December 2014
- 年：2014
- 卷：28
- 期：12
- 页码：3500-3504
- 全文大小：203 KB
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15. Hulscher JBF, ter Hofstede E, Kloek J, Obertop H, De Haan P, Van Lanschot JJB (2000) Injury to the major airways during subtotal esophagectomy: incidence, management, and sequelae. J Thorac Cardiovasc Surg 120: - 作者单位：Ahmed Sharata (1) (2)
Neil H. Bhayani (1)
Christy M. Dunst (2)
Ashwin A. Kurian (1)
Kevin M. Reavis (2)
Lee L. Swanstr?m (2)
1. Providence Portland Cancer Center, 4805 NE Glisan Street, #6N60, Portland, OR, 97213, USA
2. GMIS Division, Oregon Clinic, Portland, OR, USA - ISSN：1432-2218
文摘
Background Fistulae between the tracheobronchial tree and the gastric conduit post-esophagectomy are a rare but sometimes fatal complication. Clinical presentation can range from asymptomatic to acute pulmonary decompensation. Traditional management options, such as esophageal exclusion alone or combined with transthoracic fistula division, and closure (with tissue interposition), are highly invasive, technically difficult, and associated with variable success rates. This video presents closure of highly complex, chronic esophagobronchial fistula (EBF) using simultaneous bronchoscopic and upper endoscopic techniques. Methods Diagnostic bronchoscopy and upper endoscopy are performed to assess the size and location of fistulae. Fistulae with sufficient luminal size to accommodate a biologic plug were selected for treatment. Steps of EBF plug insertion. (1) Wire across fistula with ends exposed through the mouth. (2) Delivery sheath passed across wire from bronchial side to esophageal side (3) Plug loaded on the esophageal side of the sheath. (4) Plug pulled into position across the fistula from esophageal to bronchial side. (5) Delivery sheath released from bronchial side. Results Two of four fistulae were suitable for plug therapy. A temporary covered-stent was placed to help maintain the plugs in place. Endoscopy at 1?month showed healing of the plugged fistula following stent removal. Respiratory symptoms were improved with no further episodes of pneumonia. Over course of 2?years, the patient has required three additional endoscopic procedures to control new fistulae from this broad area of exposed lung paranchyma, but the initial fistula plug repair is durable. Conclusion Post-esophagectomy fistula is a morbid complication and the surgical treatments available are highly morbid and have variable success rates. Due to the development of new endoscopic technologies, the endotherapy has assumed new prominence for treatment of enteric fistula. This complex case illustrates feasibility of endoscopic fistula treatment using dual scope, biologic plug application which effectively controlled this patient’s EBF symptoms.