CC BY 4.0 · Endoscopy 2023; 55(S 01): E1075-E1076
DOI: 10.1055/a-2155-3369
E-Videos

Successful closure of thoracogastric airway fistula with occluder devices and coils under fluoroscopic guidance

Yifan Li
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
,
Zongming Li
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
,
Yahua Li
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
,
Zhen Li
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
,
Kewei Ren
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
› Author Affiliations
 

The application of esophageal stent closure of fistulas is limited in application to thoracogastric airway fistulas due to changes in anatomical structure after surgery. Additionally, the unique location of three-branch orificium fistulas and large orificium fistulas can cause complications such as stent displacement and lax sealing [1] [2].

The patient in this case, a 56-year-old man, experienced a thoracogastric airway fistula after radical esophagectomy. Despite receiving prior esophageal stent treatment, the patient experienced a recurrence of symptoms 5 months post-surgery, worsening his nutritional status and quality of life. Given the patientʼs large fistula and the potential for incomplete sealing with airway stenting, a therapeutic regimen involving coils combined with occlusive devices was proposed.

After determining the location of the fistula ([Fig. 1], [Fig. 2], [Fig. 3], [Video 1]), occlusion was performed using a 5-Fr vertebral catheter and hydrophilic film guidewire introduced through the fistula on the digestive tract side. A stiff guidewire was introduced and sent through the 8-Fr sheath tube to facilitate the introduction of a 9-mm septal occluder, which was accurately positioned and released. Further, the vertebral artery catheter was introduced into the right trachea through the gastropleural and tracheal fistula, and the delivery sheath was exchanged. Sequentially, the 6-mm ventricular septal occlusion device was employed to occlude the bronchothoracic fistula, followed by the 4-mm patent ductus arteriosus occlusion device to obstruct the fistula. Ultimately, the 8-mm patent ductus arteriosus occlusive device sealed the fistula. Additionally, three 6-mm × 14-mm coils were utilized to fill the gap of the occlusion device.

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Fig. 1 The fistula located at the superior carina was observed via bronchoscopy.
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Fig. 2 Chest computed tomography indicated that the bronchus exhibits communication with both the thorax and stomach.
Zoom Image
Fig. 3 Following the administration of selective esophagography, the development of a bronchial contour was observed.

Video 1 Thoracogastric airway fistula closed by occluder devices and coils under fluoroscopic guidance.


Quality:

Re-examination demonstrated the successful closure of the thoracogastrotracheal fistula ([Fig. 4]). The device offers effective physical obstruction for gas and gastric juice isolation, endothelial cell proliferation and granulation tissue adhesion. Compared to the airway stent, it exhibits reduced airway mucosal and ciliary damage, thereby mitigating the complications arising from sputum retention [3] [4].

Zoom Image
Fig. 4 After a period of 6 months, bronchoscopy revealed the presence of the occluder device at the distal end of the trachea, with yellow sputum adhering to its surface and little granulation hyperplasia.

Endoscopy_UCTN_Code_CPL_1AH_2AG

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Competing interests

The authors declare that they have no conflict of interest.

  • References

  • 1 Spaander MCW, van der Bogt RD, Baron TH. et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021. Endoscopy 2021; 53: 751-762
  • 2 Guturu P, Bilal M, Rangasetty U. et al. Endoscopic closure of esophagopleural fistula with AMPLATZER atrial septal defect closure device. Am J Gastroenterol 2019; 114: 198
  • 3 Belle A, Lorut C, Lefebvre A. et al. Amplatzer occluders for refractory esophago-respiratory fistulas: a case series. Endosc Int Open 2021; 9: E1350-E1354
  • 4 Papiashvilli M, Bar I, Sasson L. et al. Endobronchial closure of recurrent bronchopleural and tracheopleural fistulae by two amplatzer devices. Heart Lung Circ 2013; 22: 959-961

Corresponding author

Kewei Ren, MD
Department of Interventional Radiology
The First Affiliated Hospital of Zhengzhou University
No. 1 Jianshe East Road, Erqi District
Zhengzhou, 450052, Henan
China   

Publication History

Article published online:
27 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Spaander MCW, van der Bogt RD, Baron TH. et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021. Endoscopy 2021; 53: 751-762
  • 2 Guturu P, Bilal M, Rangasetty U. et al. Endoscopic closure of esophagopleural fistula with AMPLATZER atrial septal defect closure device. Am J Gastroenterol 2019; 114: 198
  • 3 Belle A, Lorut C, Lefebvre A. et al. Amplatzer occluders for refractory esophago-respiratory fistulas: a case series. Endosc Int Open 2021; 9: E1350-E1354
  • 4 Papiashvilli M, Bar I, Sasson L. et al. Endobronchial closure of recurrent bronchopleural and tracheopleural fistulae by two amplatzer devices. Heart Lung Circ 2013; 22: 959-961

Zoom Image
Fig. 1 The fistula located at the superior carina was observed via bronchoscopy.
Zoom Image
Fig. 2 Chest computed tomography indicated that the bronchus exhibits communication with both the thorax and stomach.
Zoom Image
Fig. 3 Following the administration of selective esophagography, the development of a bronchial contour was observed.
Zoom Image
Fig. 4 After a period of 6 months, bronchoscopy revealed the presence of the occluder device at the distal end of the trachea, with yellow sputum adhering to its surface and little granulation hyperplasia.