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DOI: 10.1055/s-0042-116432
Successful endoscopic closure of multiple tracheoesophageal fistulas following implantation of two atrial septal defect occluders
Corresponding author
Publication History
Publication Date:
16 November 2016 (online)
Chronic tracheoesophageal fistulas [TEFs] represent one of the greatest challenges for endoscopists [1]. A 63-year-old man diagnosed with adenocarcinoma of the esophagogastric junction was treated with neoadjuvant chemoradiotherapy and esophagectomy. He developed two TEFs, which required the implantation of two self-expandable stents and a feeding jejunostomy. The prostheses were withdrawn 3 months later, and a tracheal prosthesis was put in place.
Given the persistence of the fistulas, the patient was referred to our center. Endoscopy and bronchoscopy revealed two fistulous orifices, 8 mm in diameter and 1 cm apart ([Fig. 1]).
The fistulas were closed using two atrial septal defect occluders (ASDO, Amplatzer-type prosthesis; AGA Medical Corporation, Golden Valley, Minnesota, USA), which are normally used for closure of interauricular septal defects [2]. A pediatric endoscope was inserted into the trachea and the two fistulous orifices were identified. Through one of these, access was gained to the lumen of the esophagus and the gastric plasty by inserting a 0.035-inch guidewire.
Once the pediatric endoscope had been withdrawn from the trachea, and under endoscopic vision from the esophagus, an ASDO with an 8-mm neck and two flaps was placed from the trachea, over the guidewire, and into the esophagus to seal off the fistulous tract between the lumen of the trachea and esophagus ([Fig. 2] and [Fig. 3]).
Three weeks later, the procedure was repeated using a second ASDO with a 4-mm neck and 13-mm diameter flaps, which occluded the esophageal and tracheal lumen of the other fistula ([Fig. 4], [Fig. 5, ] [Video 1]). The patient resumed oral feeding.
Quality:
Endoscopic reviews at 3 and 4 months confirmed healing of the fistulas.
Since the description by Rabenstein of the use of ASDOs in the treatment of TEFs, several authors have confirmed the safety and efficacy of this procedure in TEFs [3] [4] [5].
Endoscopy_UCTN_Code_TTT_1AQ_2AG
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Competing interests: None
Acknowledgments
The authors are grateful to Paul Miler, PhD, for help with the English and Teresa Gonzalez for transcribing the manuscript.
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References
- 1 Chauhan SS, Long JD. Management of tracheoesophageal fistulas in adults. Curr Treat Options Gastroenterol 2004; 7: 31-40
- 2 Pineda AM, Mihos CG, Singla S et al. Percutaneous closure of intracardiac defects in adults: state of the art. J Invasive Cardiol 2015; 27: 561-572
- 3 Rabenstein T, Boosfeld C, Henrich R et al. First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy. Chest 2006; 130: 906-909
- 4 Repici A, Presbitero P, Carlino A et al. First human case of esophagus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc 2010; 71: 867-869
- 5 Coppola F, Boccuzzi G, Rossi G et al. Cardiac septal umbrella for closure of a tracheoesophageal fistula. Endoscopy 2010; 42 (Suppl. 02) E318-319
Corresponding author
-
References
- 1 Chauhan SS, Long JD. Management of tracheoesophageal fistulas in adults. Curr Treat Options Gastroenterol 2004; 7: 31-40
- 2 Pineda AM, Mihos CG, Singla S et al. Percutaneous closure of intracardiac defects in adults: state of the art. J Invasive Cardiol 2015; 27: 561-572
- 3 Rabenstein T, Boosfeld C, Henrich R et al. First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy. Chest 2006; 130: 906-909
- 4 Repici A, Presbitero P, Carlino A et al. First human case of esophagus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc 2010; 71: 867-869
- 5 Coppola F, Boccuzzi G, Rossi G et al. Cardiac septal umbrella for closure of a tracheoesophageal fistula. Endoscopy 2010; 42 (Suppl. 02) E318-319