Post written by Margherita Costanza Maregatti, MD, and Giuseppe De Roberto, MD, from the Division of Endoscopy, European Institute of Oncology, IRCCS, Milan, Italy.

This video presents endoscopic management of a postsurgical bronchoesophageal fistula that developed 6 weeks after right upper lobectomy for a lung adenocarcinoma in a 50-year-old woman. The fistula measured approximately 7 mm on the esophageal side and was associated with significant fibrosis.

After multidisciplinary discussion, surgery was considered highly invasive and potentially morbid. We therefore opted for an endoscopic approach. Following edge freshening, a through-the-scope helical tacking system (X-Tack, Boston Scientific, Marlborough, Mass, USA) was used to approximate the fistula margins. Complete closure was then achieved with a novel anchor-pronged through-the-scope clip. Follow-up endoscopy and contrast study confirmed complete closure, which remained durable at 10 months.

Bronchoesophageal fistulas are rare but challenging adverse events, and there is no standardized endoscopic treatment strategy. This case demonstrates a successful minimally invasive alternative to major surgical reintervention. We felt it was important to highlight how combining 2 complementary closure devices can overcome technical difficulties related to fibrosis and irregular fistula morphology, expanding the therapeutic options available to endoscopists.

The key lesson is the value of tailoring closure techniques to fistula characteristics. In fibrotic and irregular defects, clips alone may be insufficient. The helical tacking system can effectively approximate tissue, creating the conditions for successful clip deployment and durable closure. This combined strategy may represent a useful option for selected complex fistulas when conventional endoscopic approaches are unlikely to succeed.

Endoscopic evidence of bronchoesophageal fistula.

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