Endoscopy 2014; 46(S 01): E54-E55
DOI: 10.1055/s-0033-1359117
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Treatment of a congenital esophageal fistula by injection of autologous fat

Manuel Moretó
1   Department of Gastroenterology, Hospital Universitario de Cruces, Barakaldo, Spain
,
Javier Gabilondo
2   Department of Plastic Surgery, Hospital Universitario de Cruces, Barakaldo, Spain
,
Fernando Fernandez-Samaniego
2   Department of Plastic Surgery, Hospital Universitario de Cruces, Barakaldo, Spain
› Author Affiliations
Further Information

Corresponding author

Manuel Moretó, MD
Department of Gastroenterology
Hospital Universitario de Cruces
Pl. de Cruces s/n
Barakaldo 48903
Spain   
Fax: +34-94-6006358   

Publication History

Publication Date:
12 February 2014 (online)

 

The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. This procedure has also been used to prevent aspiration after vocal fold paralysis [1], and to treat vesicoureteral reflux [2]. Tracheo-esophageal fistula may present as an isolated defect or it may be associated with esophageal atresia. The treatment of congenital tracheo-esophageal fistulas is usually based on surgical procedures [3]. We present a preliminary report of a new endoscopic mode of therapy.

A 55-year-old man suffered from pneumonia and had frequent coughing episodes, especially after swallowing liquids. An orifice was identified by esophagogram ([Fig. 1]) and by endoscopy ([Fig. 2]). Fatty tissue was obtained from the abdominal subcutaneous tissue by a suction-assisted procedure. A total of 60 mL of fatty tissue was obtained. After centrifugation at 3000 rpm for 3 minutes, three layers were clearly visible ([Fig. 3]): at the bottom, a component containing mainly blood residues and serum; in the middle, presumably viable fatty tissue; and, finally, at the top, an oily component that was discarded.

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Fig. 1 Initial esophagogram before treatment, clearly showing a leak of contrast towards the tracheobronchial tree.
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Fig. 2 Endoscopic image of the esophageal fistula.
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Fig. 3 Fat obtained by liposuction and managed by centrifugation. The three layers are apparent.

Several passes of a biopsy probe were carried out in order to traumatize the fistulous surface and thus gain adhesiveness. Next, some 15 – 20 mL of the infranatant solution, the presumably viable fatty tissue, was injected using a pressurized injection device and a 17 – to 18-G cannula, to close the fistula.

Ten months later, endoscopic ultrasonography revealed a hyperechoic collection ([Fig. 4]), although a smaller esophageal mucosal orifice still persisted. An additional therapeutic session was decided on.

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Fig. 4 Endoscopic ultrasonogram of the fatty deposit (arrowheads).

Two years later ([Fig. 5]), an esophagogram did not reveal a fistula ([Fig. 6]), and the patient remains asymptomatic 11 years later.

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Fig. 5 Endoscopic image of protruding esophageal treated area 2 years after injection.
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Fig. 6 Later esophagogram showing no fistulous leak.

This preliminary report confirms that injection of autologous fatty tissue can persist as a long-lasting graft, suggesting several endoscopic applications.

Endoscopy_UCTN_Code_TTT_1AO_2AI


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Competing interests: None

  • References

  • 1 Sato K, Umeno H, Nakashima T. Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis. Ann Otol Rhinol Laryngol 2004; 113: 87-92
  • 2 Matthews RD, Christensen JP, Canning DA. Persistence of autologous free fat transplant in bladder submucosa of rats. J Urol 1994; 152: 819-821
  • 3 Genty E, Attal P, Nicollas R et al. Congenital tracheoesophageal fistula without esophageal atresia. Int J Pediatr Otorhinolaryngol 1999; 48: 231-238

Corresponding author

Manuel Moretó, MD
Department of Gastroenterology
Hospital Universitario de Cruces
Pl. de Cruces s/n
Barakaldo 48903
Spain   
Fax: +34-94-6006358   

  • References

  • 1 Sato K, Umeno H, Nakashima T. Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis. Ann Otol Rhinol Laryngol 2004; 113: 87-92
  • 2 Matthews RD, Christensen JP, Canning DA. Persistence of autologous free fat transplant in bladder submucosa of rats. J Urol 1994; 152: 819-821
  • 3 Genty E, Attal P, Nicollas R et al. Congenital tracheoesophageal fistula without esophageal atresia. Int J Pediatr Otorhinolaryngol 1999; 48: 231-238

Zoom Image
Fig. 1 Initial esophagogram before treatment, clearly showing a leak of contrast towards the tracheobronchial tree.
Zoom Image
Fig. 2 Endoscopic image of the esophageal fistula.
Zoom Image
Fig. 3 Fat obtained by liposuction and managed by centrifugation. The three layers are apparent.
Zoom Image
Fig. 4 Endoscopic ultrasonogram of the fatty deposit (arrowheads).
Zoom Image
Fig. 5 Endoscopic image of protruding esophageal treated area 2 years after injection.
Zoom Image
Fig. 6 Later esophagogram showing no fistulous leak.