Post written by Ariel A. Benson, MD, from the Faculty of Medicine, Hebrew University of Jerusalem, and the Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel.

In this video we describe the evaluation and treatment of a chronic, symptomatic tracheoesophageal (TE) fistula in an adult patient. The etiology of the patient’s TE fistula was unknown but was hypothesized to be congenital or acquired at a young age. Given the chronicity and complexity (multiple openings in the esophagus) of the patient’s TE fistula, the established treatment option of esophageal stent or endoscopic clip placement would be difficult. In addition, thoracic surgery for treatment of the patient’s TE fistula involved surgical risks. Therefore, after discussing the options in a multidisciplinary meeting and discussion with the patient, the patient and treatment team sought to pursue closure of the TE fistula via endoscopic suturing. After initial coagulation of the area of the TE fistula with argon plasma coagulation, endoscopic suturing was performed to close the TE fistula. Post-suturing fluoroscopy showed no leakage of contrast. The patient had short-term improvement of symptoms.

Given the limited options available for management of chronic TE fistulas, we felt it was important to share our case of endoscopic suturing closure of the patient’s TE fistula. Furthermore, if symptoms recur, repeat attempt at endoscopic suturing closure may be considered.

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