A hybrid endoscopic technique to close tracheoesophageal fistula

Post written by Maoyin Pang, MD, PhD, from the Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.

A 56-year-old male with a history of laryngeal malignancy status post laryngectomy and permanent tracheostomy and tracheoesophageal voice prosthesis placed 12 years ago was referred to our clinic for recurrent aspiration of both liquid and solid foods. A recent video fluoroscopic swallow study showed a tracheoesophageal fistula (TEF) which was confirmed by endoscopy as a 5 mm fistula opening in the upper third of the esophagus. We decided to use a hybrid endoscopic technique to close the fistula. First, we performed small mucosal resections surrounding the fistula opening on the esophageal side, to help tissue apposition; second, we used an endoscopic suturing device to close the denuded tissues with an over-the-scope full thickness suturing technique. By resecting the squamous cell epithelialized mucosa with endoscopic mucosal resection (EMR), followed by full-thickness suturing, the denuded fresh tissue surface could subsequently enhance tissue regeneration and thus decrease the chances of recurrence. Esophagram on the following day confirmed that there was no contrast extravasation at the previous site of TEF. On 30 days follow-up, the patient reported that he no longer had cough spells during eating or drinking.

This technique could be an alternative technique to achieve the endoscopic closure of chronic fistula secondary from benign etiology. It can even be considered to be applied to other types of chronic fistula.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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