Endoscopic occlusion with silicone spigots for the closure of refractory esophago-bronchiole fistula after esophagectomy

Figure 1 The radiographic image showed an esophago-bronchiole fistula from the anastomose to the right B1 bronchiole (arrow) and approximately 5 cm stenosis of the upper gastric tube (arrowhead).

Figure 2 The epithelium of the esophago-bronchiole fistula was burned using argon plasma coagulation (arrow).

Figure 3 The endobronchial Watanabe spigot was penetrated through its long axis by the guidewire (A) (Push and Slide method[9]; B: Under fluoroscopic and endoscopic guidance, the endobronchial Watanabe spigot (arrow) was wedged into the esophago-bronchiole fistula.

Figure 4 The radiographic image just after the insertion showed the fistula occluded by the endobronchial Watanabe spigot (A, arrow); B: In the endoscopic image just after occlusion, it was confirmed that the endobronchial Watanabe spigot is in the target fistula.

Figure 5 Since the endoscopic occlusion, the patient has not developed recurrence of the fistula for three years. Two endobronchial Watanabe spigots remain (A, arrow); B: In the endoscopic image passed for three years after occlusion, the fistula has disappeared; C: In computed tomography passed for three years after occlusion, two endobronchial Watanabe spigots remain (arrow).