Using a Miniature Stapler to Divide a Mucosal Bridge at the Anastomosis after Gastric Pull-up for Iatrogenic Tracheoesophageal Fistula

Abstract

We report the first use of a miniature stapler to divide a mucosal bridge at the gastroesophageal junction after complex esophageal atresia (EA) repair. A 4-year-old girl was referred to our center after treatment of EA elsewhere. On our initial enodoscopy, a large iatrogenic tracheoesophageal fistula had formed, prompting us to perform a tracheoplasty and gastric interposition. One year after recovery, she had dysphagia with solid food. Upon endoscopy, a mucosal bridge was noted at the gastroesophageal anastomosis. This bridge was divided under endoscopy using a 5 mm miniature stapler. No complications were noted. Upon follow-up, she had no more complaints with solid food. Our report shows that the mucosal bridges may cause dysphagia after EA repair and can be safely divided using a miniature stapler.

Keywords

esophageal mucosal bridge - miniature stapler - iatrogenic tracheoesophageal fistula

• References

• 1 Chapuy L, Pomerleau M, Perreault P, Faure C. Mucosal bridge as a cause of dysphagia after surgery for esophageal atresia. Can J Gastroenterol Hepatol 2014; 28 (07) 350
• 2 Santosham R. Management of acquired benign tracheoesophageal fistulae. Thorac Surg Clin 2018; 28 (03) 385-392
• 3 Sunkara T, Then EO, Yarlagadda KS, Jhaveri M, Gaduputi V. An innocent esophageal mucosal bridge: case report and literature review. J Investig Med High Impact Case Rep 2018; 6: 2324709618767204 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881978/. Accessed February 6, 2019
• 4 Hanai H, Honda S, Sugimoto K. , et al. Endoscopic therapy for multiple mucosal bridges in the esophagus of a patient with Crohn's disease. Gastrointest Endosc 1999; 50 (05) 715-717
• 5 Wilmsen J, Baumbach R, Stüker D. , et al. New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: a case series. World J Gastroenterol 2017; 23 (17) 3084-3091