Published online Jul 28, 2017. doi: 10.3748/wjg.v23.i28.5253
Peer-review started: February 9, 2017
First decision: April 21, 2017
Revised: May 4, 2017
Accepted: June 12, 2017
Article in press: June 12, 2017
Published online: July 28, 2017
A 65-year-old man with cT1bN0M0 stage I middle thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route after preoperative carbon-ion radiotherapy and chemotherapy in a clinical trial. Anastomotic leakage occurred, but it spontaneously improved. At six months after the operation, he was rehospitalized with a cough and dysphagia. An esophago-bronchiole fistula and stenosis of the gastric tube were observed. He first underwent stent placement in the gastric tube. Two weeks later, the syringeal epithelium was burned by argon plasma coagulation after stent removal. Endoscopic occlusion was then performed for the fistula with two guidewire-assisted silicone spigots. Two weeks later, he was discharged on an oral diet, and he has not developed recurrence of the fistula or cancer for three years. This is the first report of endoscopic occlusion with a guidewire-assisted silicone spigot through the esophagus.
Core tip: Anastomotic leakage, which is a complication of esophagectomy, sometimes causes a refractory fistula. An esophago-bronchiole fistula (EBF) is a relatively rare but serious complication. We performed endoscopic occlusion using an endobronchial Watanabe spigot (EWS), a type of silicone bronchial blocker that is widely used in the respiratory field to treat pulmonary air leak, hemoptysis and bronchopleural fistula. We herein report a new and unique technique using the EWS to close a refractory EBF after esophagectomy. This report is the first to show that endoscopic occlusion using the EWS through the esophagus can simply and safely repair a refractory fistula.