Gastro-bronchial fistula closed by endoscopic fistula plug (with video)

Sharata, Ahmed; Bhayani, Neil H.; Dunst, Christy M.; Kurian, Ashwin A.; Reavis, Kevin M.; Swanström, Lee L.

doi:10.1007/s00464-014-3631-6

Cited by 2 publications

(3 citation statements)

References 31 publications

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“…As patients often present with malnutrition and repeated pneumonia, prompt administration of broad-spectrum antibiotics, gastric drainage, maintenance of fluid and electrolyte balance, and chest physiotherapy are necessary before definitive surgery. Even though there is no standard treatment for GBF, several interventions have been proposed in the past 20 years, such as esophageal stenting, tracheobronchial Y-shaped stenting, over-the-scope clips, fistula plugs, and surgical repair with muscle flaps or bovine pericardium [2,6,9,12–14] . Interestingly, Li et al have demonstrated that surgical repair has a greater long-term survival rate than other non-invasive treatments [10] …”

Section: Discussionmentioning

confidence: 99%

“…Even though there is no standard treatment for GBF, several interventions have been proposed in the past 20 years, such as esophageal stenting, tracheobronchial Y-shaped stenting, over-the-scope clips, fistula plugs, and surgical repair with muscle flaps or bovine pericardium. [2,6,9,[12][13][14] Interestingly, Li et al have demonstrated that surgical repair has a greater long-term survival rate than other non-invasive treatments. [10]…”

Section: Literature Reviewmentioning

confidence: 99%

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Airway management during left-sided gastrobronchial fistula repair after esophagectomy for esophageal carcinoma

Wang¹,

Yuan²,

Wu³

2021

Medicine

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Rationale: Gastrobronchial fistula (GBF) is a rare but life-threatening complication of esophagectomy with gastric conduit reconstruction, and airway management during fistula repair is challenging. Here, we describe airway management in a patient undergoing left-sided GBF repair using video-assisted thoracoscopic surgery. Patient concerns: A 63-year-old man diagnosed with esophageal carcinoma underwent esophagectomy with reconstruction by gastric pull-up and tabularization of the gastric conduit. Subsequently, about 8 weeks later, the patient presented with repeated pneumonia and a 1-week history of cough with significant sputum, dysphagia, and repeated fever. Diagnosis: GBF, a rare postoperative complication, was located on the left main bronchus at 2 cm below the carina and was diagnosed based on findings from gastroscopy, flexible bronchoscopy, and thoracic computed tomography scan with contrast. Interventions: We performed left-sided one-lung ventilation (OLV) under total intravenous anesthesia instead of inhalational anesthetics. The left-sided OLV, with positive end-expiratory pressure (PEEP) and nasogastric tube decompression, generated positive pressure across the fistula. It prevented backflow into the left main bronchus. Total intravenous anesthesia preserved hypoxic pulmonary vasoconstriction and prevented adverse effects associated with inhalational anesthetics. A right-sided, double-lumen endotracheal tube was inserted after anesthesia induction, and surgical repair was performed through a right-sided video-assisted thoracoscopic surgery. Outcomes: Intraoperative hemodynamics remained relatively stable, except for brief tachycardia at 113 beats/min. Arterial blood gas analysis revealed pH 7.17 and PaO 2 89.1 mmHg upon 100% oxygenation, along with hypercapnia (PaCO 2 77.1 mmHg), indicating respiratory acidosis. During OLV, pulse oximetry remained higher than 92%. The defect in the left main bronchus was successfully sutured after dissecting the fistula between the left main bronchus and the gastric conduit, and subsequently, OLV resulted in ideal ventilation. Lessons: A left-sided GBF could lead to leakage from the OLV during surgery. Possible aspiration or alveolar hypoventilation due to this leakage is a major concern during airway management before surgical repair of the main bronchus.

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Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Airway management during left-sided gastrobronchial fistula repair after esophagectomy for esophageal carcinoma

Wang¹,

Yuan²,

Wu³

2021

Medicine

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“…Endoscopic devices that are commonly used include stent, clips, plugs, fibrin glue, and vacuum-assisted closure sponge. [5][6][7][8][9][10][11] In this paper, we describe a case series of postesophagectomy GBF which were managed endoscopically using over-the-scope-clip (OTSC) (OTSC system; Ovesco Endoscopy AG, Tubingen, Germany).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of gastro‐bronchial fistula following two‐stage esophagectomy using over‐the‐scope‐clip (OTSC): Case series

Tan

Kyaw

Farhangmehr

et al. 2020

Adv in Digestive Medicine

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Post-esophagectomy gastro-bronchial fistula (GBF) has significant morbidity and mortality. Management of GBF remains non standardized due to its rarity and limited available evidence. Reoperation and surgical repair have been the main approach. More recently, multimodal endoscopic treatment is gaining popularity as primary treatment option due to its relatively non invasiveness, increasing evidence of success rate, and reduced morbidity. We present a case series of post-esophagectomy GBF managed endoscopically using over-thescope-clip (OTSC). A dedicated, prospective, and contemporaneous regional upper gastrointestinal cancer database was searched to identify postesophagectomy GBF from January 2015 to December 2017. Clinical notes and investigation images of identified cases were analyzed. Three patients developed post-esophagectomy GBF during the study period. The mean age of patients was 53. The mean time of GBF diagnosis was 233 days (range: 20-608).Two patients had endoscopic stent placement prior to OTSC application. Primary technical success was achieved in all patients. No adverse events were reported. Two patients had complete healing of GBF and the mean healing time was 15 days (range: 6-24). One patient who had significant co-morbidities (peripheral arterial disease, diabetes, hepatitis C, rheumatoid arthritis, and heavy smoker) developed a persistent leak of GBF and died from a cardiac event. GBF and its surgical treatment are associated with high morbidity and mortality. We present this case series where two out of three patients with GBF were successfully treated with this modality. Endoscopic therapy incorporating OTSC placement is a feasible option in the management of postesophagectomy GBF. Further studies are required to understand and establish its role in the treatment algorithm of post-esophagectomy GBF.

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Gastro-bronchial fistula closed by endoscopic fistula plug (with video)

Cited by 2 publications

References 31 publications

Airway management during left-sided gastrobronchial fistula repair after esophagectomy for esophageal carcinoma

Airway management during left-sided gastrobronchial fistula repair after esophagectomy for esophageal carcinoma

Endoscopic management of gastro‐bronchial fistula following two‐stage esophagectomy using over‐the‐scope‐clip (OTSC): Case series

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