First Human Case of Esophago-Tracheal Fistula Closure by Using a Cardiac Septal Occluder

Use of cardiac septal occluder device on upper GI anastomotic dehiscences: a new endoscopic approach (with video)

“…6 Use of the ASOD for GI fistula closure has since been reported by others. 5,7 This report is the first to describe ASOD use for the repair of a large dehiscence. The current ASOD had a 46-mm proximal disk diameter and a 36-mm waist length.…”

“…However, this device has recently been reported as being useful in the treatment of GI leaks. [4][5][6][7] This report describes the successful treatment of a large gastroesophageal anastomotic dehiscence using an ASOD with an endoscopic approach.…”

Endoscopic closure devices

“…However, the device has been used off-label for the closure of GI fistulae. [12][13][14][15] This dumbbell-shaped device consists of 2 self-expandable disks composed of nitinol mesh with polyester fabric connected by a short waist. It is constrained within a 70-cm delivery catheter and deployed over an endoscopically placed guidewire similar to a selfexpandable metal stent.…”

“…[12][13][14][15] SAFETY A single perforation was reported after placement of the OTSC for a bleeding duodenal ulcer. 57 Mucosal lacerations have been reported after advancement of the OTSC through the upper esophageal sphincter and esophagus.…”

The best endoscopic method to close refractory esophageal fistula: vacuum? clips? stenting? sheet? glue? ablation?

“…We must emphasize that use of this material is indicated in the absence of infection and protein lysis, upstream stenosis or high-grade esophageal axis deviation as elevated intraluminal pressure acts as fistula maintenance factor. Other approaches are also described, such as use of endoscopic insertion of Vicryl plug along with fibrin glue [12], solo injection of cyanoacrylate [13], overstitch closure of esophagus leaks combined with vacuum therapy [14], bronchoscopic closure of tracheoesophageal fistulas [15] and placement of cardiac septal occluder (CSDO) in esophagotracheal fistula closure [16].…”