Uesato M, Kono T, Akutsu Y, Murakami K, Kagaya A, Muto Y, Nakano A, Aikawa M, Tamachi T, Amagai H, Arasawa T, Muto Y, Matsubara H. Endoscopic occlusion with silicone spigots for the closure of refractory esophago-bronchiole fistula after esophagectomy. World J Gastroenterol 2017; 23(28): 5253-5256 [PMID: 28811720 DOI: 10.3748/wjg.v23.i28.5253]
Corresponding Author of This Article
Masaya Uesato, MD, Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. uesato@faculty.chiba-u.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Masaya Uesato, Tsuguaki Kono, Yasunori Akutsu, Kentarou Murakami, Akiko Kagaya, Yorihiko Muto, Akira Nakano, Mizuho Aikawa, Tomohide Tamachi, Hiroyuki Amagai, Takahiro Arasawa, Yasuhide Muto, Hisahiro Matsubara, Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
Author contributions: Uesato M wrote the manuscript; Uesato M, Kono T, Akutsu Y, Murakami K, Kagaya A, Muto Y, Nakano A, Aikawa M, Tamachi T, Amagai H, Arasawa T, Muto Y diagnosed and treated; all authors discussed the results and commented on the manuscript.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: The authors state that they have no conflict of interest regarding this case report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaya Uesato, MD, Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. uesato@faculty.chiba-u.jp
Telephone: +81-43-2262110 Fax: +81-43-2262113
Received: February 3, 2017 Peer-review started: February 9, 2017 First decision: April 21, 2017 Revised: May 4, 2017 Accepted: June 12, 2017 Article in press: June 12, 2017 Published online: July 28, 2017 Processing time: 174 Days and 17.2 Hours
Abstract
A 65-year-old man with cT1bN0M0 stage I middle thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route after preoperative carbon-ion radiotherapy and chemotherapy in a clinical trial. Anastomotic leakage occurred, but it spontaneously improved. At six months after the operation, he was rehospitalized with a cough and dysphagia. An esophago-bronchiole fistula and stenosis of the gastric tube were observed. He first underwent stent placement in the gastric tube. Two weeks later, the syringeal epithelium was burned by argon plasma coagulation after stent removal. Endoscopic occlusion was then performed for the fistula with two guidewire-assisted silicone spigots. Two weeks later, he was discharged on an oral diet, and he has not developed recurrence of the fistula or cancer for three years. This is the first report of endoscopic occlusion with a guidewire-assisted silicone spigot through the esophagus.
Core tip: Anastomotic leakage, which is a complication of esophagectomy, sometimes causes a refractory fistula. An esophago-bronchiole fistula (EBF) is a relatively rare but serious complication. We performed endoscopic occlusion using an endobronchial Watanabe spigot (EWS), a type of silicone bronchial blocker that is widely used in the respiratory field to treat pulmonary air leak, hemoptysis and bronchopleural fistula. We herein report a new and unique technique using the EWS to close a refractory EBF after esophagectomy. This report is the first to show that endoscopic occlusion using the EWS through the esophagus can simply and safely repair a refractory fistula.
