Post written by Sarah Durbin, BS, Jose Luis Aranez, MD, and Robert Jay Sealock, MD, from the Baylor College of Medicine, Houston, Texas.

The case details a patient with a distant history of esophagectomy with gastric conduit that presented with a large gastrobronchial fistula resulting in necrotizing pneumonia. The patient was not an immediate candidate for surgery due to cardiopulmonary compromise. Given the large size of the defect, endoscopic closure was not considered. The large diameter of the gastric conduit could not be covered via endoscopic stenting. Therefore, endoscopic vacuum therapy (EVT) was utilized to stabilize the fistula for 11 days. During this time, the sponge was changed 3 times, and the patient improved sufficiently for ultimate surgical repair of the fistula.

Gastropulmonary fistulas are associated with high mortality due to the patient’s clinical instability and limited treatment options besides surgery. EVT is an emerging technique that can be used to treat a variety of gastrointestinal defects, including esophageal perforations and anastomotic leaks. As EVT is still a relatively new technique in the endoscopic field, new uses and modifications are being presented.

Our video highlights another successful therapeutic use of EVT. Additionally, there is currently no commercially available device for EVT, and this video demonstrates the necessary supplies and methods used for EVT. By highlighting this unique application of endoscopic vacuum therapy, we hope to increase its adoption among endoscopists in the management of complex luminal fistulae.

Read the full article online.

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