TRACHEA ESOPHAGEAL FISTULA CLOSURE WITH THERMOCOAGULATION AND FIBRIN GLUE USING DUODENOSCOPE

Aims:

To demonstrate the usefulness of side viewing endoscope in trachea oesophageal fistula closure and to demonstrate the efficacy of combined modality for endoscopic fistula closure.

Methods:

Case report: A 47 year old gentleman had accidental trauma to neck. He was on mechanical ventilator support, weaned off after tracheostomy. Trachea oesophageal fistula was detected because of cough after resuming oral diet. Surgical closure of tracheotomy and fistula was done, but fistula tract of 8 mm length and 2 mm diameter persisted for 4 months after surgery, because of which patient had coughing only with liquid diet. Forward viewing scope or bronchoscopy could not locate the fistulous opening, albeit a mound was seen in endoscopy, just below cricopharynx. Side viewing scope was used, fistula was clearly seen. Thermocoagulation of the tract was done using bipolar cautery. Under simultaneous endoscopic and bronchoscopic guidance, fistula tract closed using fibrin glue with separate injection of glue (Tisseal) followed by thrombin. Complete closure of the fistula was documented with contrast fluoroscopy. Patient became asymptomatic, when oral diet was resumed 48 hours after the procedure.

Results:

Small fistulous opening in cervical oesophagus could be better visualised with side viewing endoscope. Tract closure was achieved with thermo coagulation to facilitate healing by fibrosis, and fibrin glue injection to seal the tract. Fibrin glue was injected separately followed by distilled water injection and then thrombin injection via plastic cannula.

Conclusions:

Small trachea oesophageal fistula, which are difficult to visualise using forward viewing scope can easily be studied with side viewing endoscope. Closure of small fistula can be achieved with thermo coagulation and fibrin glue injection.