RSS-Feed abonnieren
DOI: 10.1055/a-1524-0761
Endoscopic closure of tracheoesophageal fistula with a novel dumbbell-shaped occluder
Tracheoesophageal fistula (TEF) is a challenging condition that is difficult to treat. Several reports have described successful TEF treatment with an Amplatzer occluder (AGA Medical Corporation, Plymouth, Minnesota, USA) [1] [2]. However, Daniel et al. reported the case of a benign gastrobronchial fistula patient who underwent treatment with the Amplatzer device and died of fatal hemoptysis [3]. Inspired by this case, we developed a new dumbbell-shaped occluder device [4]. Compared with the Amplatzer occluder, this device has no protrusions, which reduces the risk of bleeding; even if the patient coughs, it will not increase airway damage.
A 69-year-old man with a chronic TEF was the first patient to be successfully treated with our novel occluder ([Video 1]). He had been diagnosed 7 years previously with esophageal cancer and underwent surgery. He presented 1 year prior to treatment with cough, aspiration, and weight loss. An endoscopic examination revealed a tracheoesophageal fistula 27 cm from the incisors ([Fig. 1]), with a diameter of 0.8 cm. After several esophageal stent placements and replacements and anastomotic sutures, there was still evidence of difficulty in healing of the fistula. We therefore decided that application of this new instrument was an appropriate treatment strategy.
Video 1 Treatment of a tracheoesophageal fistula (TEF) by gastroscopy and bronchoscopy, using a newly developed dumbbell-shaped occluder.
Qualität:
![](https://www.thieme-connect.de/media/endoscopy/202207/thumbnails/10-1055-a-1524-0761-i2499ev1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
We inserted a 9-Fr catheter through the endoscope, so that the device could be introduced into the airway. After releasing the distal dilation disc under direct vision with a bronchoscope, we gently pulled the device until it was fixed against the airway wall ([Fig. 2 a]). As the flexible catheter was removed, we observed that the side of the gastroscope slowly pulled the device to release the proximal expansion disc ([Fig. 2 b]).
![](https://www.thieme-connect.de/media/endoscopy/202207/thumbnails/10-1055-a-1524-0761-i2499ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
The patient tolerated a normal diet after 2 days. By the 4-month follow-up, all of his clinical symptoms had been relieved, and his body mass index had increased from 18.5 kg/m2 to 23.6 kg/m2. Gastroscopy and tracheoscopy evaluations showed that the fistula was completely blocked, and no leakage was found on gastrointestinal radiography and computed tomography ([Fig. 3]).
![](https://www.thieme-connect.de/media/endoscopy/202207/thumbnails/10-1055-a-1524-0761-i2499ev3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
The findings of the present case demonstrate that our newly developed dumbbell-shaped occluder can effectively block a TEF, thereby providing a new method for mechanical TEF closure.
Endoscopy_UCTN_Code_TTT_1AO_2AI
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos
#
Competing interests
The authors declare that they have no conflict of interest.
-
References
- 1 Repici A, Presbitero P, Carlino A. et al. First human case of esophagus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc 2010; 71: 867-879
- 2 Guturu P, Bilal M, Rangasetty U. et al. Endoscopic closure of esophagopleural fistula with Amplatzer atrial septal defect closure device. Am J Gastroenterol 2019; 114: 198
- 3 Buitrago DH, Pinto D, Berkowitz SJ. et al. Fatal hemoptysis after closure of gastrobronchial fistula using an Amplatzer vascular device. Ann Thorac Surg 2018; 105: e71-e73
- 4 Sang H, Peng L, Zhang G. Tracheoesophageal fistula closed by a new gastrointestinal occluder device. Endoscopy 2020; DOI: 10.1055/a-1234-6702.
Corresponding author
Publikationsverlauf
Artikel online veröffentlicht:
19. Juli 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Repici A, Presbitero P, Carlino A. et al. First human case of esophagus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc 2010; 71: 867-879
- 2 Guturu P, Bilal M, Rangasetty U. et al. Endoscopic closure of esophagopleural fistula with Amplatzer atrial septal defect closure device. Am J Gastroenterol 2019; 114: 198
- 3 Buitrago DH, Pinto D, Berkowitz SJ. et al. Fatal hemoptysis after closure of gastrobronchial fistula using an Amplatzer vascular device. Ann Thorac Surg 2018; 105: e71-e73
- 4 Sang H, Peng L, Zhang G. Tracheoesophageal fistula closed by a new gastrointestinal occluder device. Endoscopy 2020; DOI: 10.1055/a-1234-6702.
![](https://www.thieme-connect.de/media/endoscopy/202207/thumbnails/10-1055-a-1524-0761-i2499ev1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202207/thumbnails/10-1055-a-1524-0761-i2499ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202207/thumbnails/10-1055-a-1524-0761-i2499ev3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)