Endoscopic submucosal dissection-based suture combined with medical adhesive for complicated tuberculous bronchoesophageal fistula: a case report

Abstract

Tuberculous bronchoesophageal fistula is a rare complication of tuberculosis. Herein, we report the case of a woman in her late 60s with a choking cough for more than 1 month. Iohexol esophagography revealed a fistulous communication between the esophagus and the right principal bronchus, and gastroscopy documented a fistulous orifice in the esophagus. Endoscopic closure with metal clips failed, and other treatment options, such as extended conservative treatment, covered self-expandable metal stents, and over-the-scope clips were rejected by the patient. Therefore, a combined therapy, endoscopic submucosal dissection-based suture combined with medical adhesive, was performed. Follow-up iohexol esophagography and gastroscopy confirmed fistula closure. During 1 year of follow-up after discharge, the bronchoesophageal fistula did not recur. Endoscopic submucosal dissection-based suture combined with medical adhesive appears to be a practical and feasible solution to complicated tuberculous bronchoesophageal fistula.

Esophagomediastinal Fistula Closed Endoscopically in a Young Patient With Tuberculosis and Human Immunodeficiency Virus

“…They form as a consequence of lymphadenitis, which occurs in about 17.6% of patients with tuberculosis and up to 35% in those with concomitant HIV [3][4][5]. Tracts develop from ruptured caseating necrotic lymph nodes that compress and erode into adjacent organs, either spontaneously or from iatrogenic procedures [2][3][4]13,14]. Fistulas can connect the esophagus with the mediastinum and lead to repeated episodes of aspiration [3,5,13].…”

“…Tracts develop from ruptured caseating necrotic lymph nodes that compress and erode into adjacent organs, either spontaneously or from iatrogenic procedures [2][3][4]13,14]. Fistulas can connect the esophagus with the mediastinum and lead to repeated episodes of aspiration [3,5,13]. Patients initially present with a choking cough from eating or drinking [3,5,13].…”

“…Fistulas can connect the esophagus with the mediastinum and lead to repeated episodes of aspiration [3,5,13]. Patients initially present with a choking cough from eating or drinking [3,5,13]. The diagnosis can be made using an esophagram, high-resolution CT, or EGD [3,5,13].…”

“…Patients initially present with a choking cough from eating or drinking [3,5,13]. The diagnosis can be made using an esophagram, high-resolution CT, or EGD [3,5,13]. The mainstay of treatment is to close the defect, control the infection, and improve nutritional status [3,5,13].…”

“…The diagnosis can be made using an esophagram, high-resolution CT, or EGD [3,5,13]. The mainstay of treatment is to close the defect, control the infection, and improve nutritional status [3,5,13]. These types of fistulas are usually surgically ligated or excised [3,15].…”