Clin Endosc.  2020 May;53(3):361-365. 10.5946/ce.2019.106.

Successful Closure of a Benign Refractory Tracheoesophageal Fistula Using an Over-the-Scope Clip after Failed Esophageal Stent Placement and Surgical Management

• Pausawasdi N
• Angkurawaranon C
• Chantarojanasiri T
• Chang A
• Wongkornrat W
• Leelakusolvong S
• Methasate A

• KMID: 2502772
• DOI: http://doi.org/10.5946/ce.2019.106

Abstract

Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.

Keyword

Tracheoesophageal fistula; Over-the-scope clip; Benign refractory tracheoesophageal fistula; Esophagorespiratory fistula

Figure

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  Fig. 1. (A) Endoscopic image demonstrates tracheoesophageal fistula (TEF) in the upper esophagus. (B) Placement of 18×120 mm PolyflexTM (Boston Scientific, Natick, MA, USA) stent.

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  Fig. 2. (A) Fully covered 18×120 mm WallflexTM (Boston Scientific, Natick, MA, USA) stent in place. (B) Persistent fistula identified after WallflexTM stent removal. TEF, tracheoesophageal fistula.

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  Fig. 3. (A) Endoscopic view of fistula closure with an over-the-scope clip. (B) Contrast injection under fluoroscopy shows no contrast leakage after placement of the clip

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  Fig. 4. Follow-up water-soluble esophagogram. (A) Contrast study performed at 4 weeks after treatment showing no leakage. (B) Contrast study performed at 16 weeks after treatment showing no leakage.

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