Combined over-the-scope and through-the-scope clips for endoscopic closure of a gastropleural fistula after Ivor-Lewis esophagectomy

Abstract Text A 48-year-old male with a persistent gastric conduit leak after Ivor-Lewis esophagectomy, despite 3 sessions of EVT, was referred to our team. Endoscopy confirmed persistence of a 25mm long defect, however, no contrast extravasation could be seen. Retroflexion allowed identification of a 4mm orifice, located deeply in the defect’s proximal end, not visible in anteflexion. Contrast instillation and guidewire passage confirmed the presence of a gastropleural fistula. A TTS-clip was placed at defect’s distal end and an OTS-clip was deployed at defect’s proximal end, enveloping the area of the 4mm orifice. One additional TTS-clip was placed between OTS-clip and previous TTS-clip to ensure complete closure of the fistula orifice [1] [2] [3].

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023

• 1 Shi H, Wang WP, Gao Q. et al. Single-stage surgical repair of airway gastric fistula after esophagectomy. J Cardiothorac Surg 2014; 9: 30
• 2 Laad AM, Al-Bayati I, Shah P. et al. Endoscopic closure of a gastropleural fistula. Endoscopy 2015; 47 (Suppl. 01) E131-132
• 3 Merrit RE, Kneuertz PJ, DM DSouza. et al. Total laparoscopic and thracoscopic Ivor Lewis esophagectoy after neoadjuvant chemoradiation with minimal overall and anastomotic complications. J Cardiothorac Surg 2019; 14: 123