Bronchogastric fistula successfully treated with the insertion of a covered bronchial stent

Endoscopic ligation technique for refractory gastrotracheal fistula

Endoscopic therapy has recently undergone remarkable progress, including the use of suturing procedures within the gastrointestinal tract using flexible endoscopes. However, existing suturing techniques primarily involve closure using instruments or continuous sutures using an endoscopic needle holder, leaving a gap in nodal suturing methods with extracorporeal ligation. This paper introduces a novel approach, the endoscopic ligation technique, wherein a flexible endoscope is utilized for nodal suturing through extracorporeal ligation.

Bronchial Stent Placement for Palliative Treatment of Pulmonary Carcinoma with Bronchial Obstruction in a Cat

A feral, domestic shorthair was evaluated for palliative treatment of a pulmonary mass with secondary pneumonia. Because of the patient's temperament and extent of the mass, tracheobronchoscopy, bronchial stenting, and biopsy were elected, followed by adjuvant radiation therapy. Stent placement across the malignantly obstructed bronchus permitted drainage and recruitment of the infected lung lobe. Uncomplicated radiation therapy, stent extension, and debulking due to tissue ingrowth were subsequently performed. Successful palliation was achieved for 323 days with subsequent progressive pulmonary and liver metastases.

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Background

Thoracogastric airway fistula (TGAF) is a serious complication of esophagectomy for esophageal cancer. We conducted a systematic review of the appropriate therapeutic options for acquired TGAF.

Methods

We performed a literature search to identify relevant studies from PubMed, EMBASE, and Web of Science using the search terms “gastric airway fistula”, “gastrotracheal fistula”, “gastrobronchial fistula”, “tracheogastric fistula”, “bronchogastric fistula”, “esophageal cancer”, and “esophagectomy”.

Result

Twenty-four studies (89 patients) were selected for analysis. Cough was the main clinical presentation of TGAF. The main bronchus was the most common place for fistulas (53/89), and 29 fistulas occurred in the trachea. Almost 73% (65/89) of patients underwent non-surgical treatment of whom 87.7% (57/65) received initial fistula closure. Twenty-three patients underwent surgery, including 19 (82.6%) with initial closure. The 1-, 2-, 3-, 6-, and 9-month survival rates in patients who underwent surgical repair were 95.65%, 95.65%, 82.61%, 72.73%, and 38.10%, respectively, and the equivalent survival rates in patients with tracheal stent placement were 91.67%, 86.67%, 71.67%, 36.96%, and 13.33%, respectively.

Conclusion

TGAF should be suspected in patients with persistent cough, especially in a recumbent position or associated with food intake. Individualized treatment should be emphasized based on the general condition of each patient.

Benign gastrobronchial fistula following oesophagectomy in a patient presenting with respiratory failure

Benign gastrobronchial fistula (GBF) is a rare but potentially life-threatening complication of oesophagectomy for malignancy. We present a case of GBF post Ivor-Lewis surgery manifesting as pulmonary sepsis and type II respiratory failure. Clues to the diagnosis were persistent hypercapnia despite high minute ventilation, aspiration of gastric content through the endotracheal tube and accumulation of air in the nasogastric drainage bag. Flexible bronchoscopy confirmed the diagnosis. Surgical exploration identified necrosis of the proximal stomach as causative factor. Despite reconstruction of the oesophagogastric anastomosis and interposition of an intercostal muscle flap, the patient developed a new episode of type II respiratory failure. Bronchoscopy revealed in situ recurrence of the fistula. Patency of the fistula was proven through application of methylene blue with subsequent gastroscopy. A conservative, symptom-based, management was conducted. The patient died 6 hours later.

Gastrotracheal fistula: Treatment with a covered elf-expanding Y-shaped metallic stent

A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital. He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously. After admission to our hospital, gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wall near the carina and the upper residual stomach. We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy. A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus. Subsequently, the fistula was closed completely. The patient tolerated the stent well and had good palliation of his symptoms.

Successful management of anastomotic leakage and lung fistula after esophagectomy

We report the successful management of a case of anastomotic leakage with a lung fistula as a complication of esophagectomy by use of a double elementary diet tube.

The utility of stenting in the treatment of airway gastric fistula after esophagectomy for esophageal cancer

BACKGROUND

The purpose of this study was to determine the overall efficacy of airway stenting in the treatment of patients developing airway gastric fistula (AGF) after esophagectomy.

METHODS

MEDLINE/PubMed search from January 1990 to November 2011 was conducted using the search terms "esophageal cancer," "esophagectomy," "airway fistula," "tracheal fistula," "bronchial fistula," and "stent" alone and in combination. The authors identified 2 case series and 8 case reports. All case series and reports were reviewed to include the number of patients, the type of stent utilized, the location of AGF (tracheal or bronchial), the overall success in closure, recurrence (to include time to recurrence), and outcome if available. The Mantel-Haenszel analysis was performed on the basis of the type of stent and location of the AGF as it related to efficacy and outcome.

CONCLUSIONS

AGF after esophagectomy for esophageal cancer is rare. Although surgical repair offers definitive treatment, the operative risk in such patients is high. With a nonsurgical approach, an analysis of available case reports/series suggests a trend toward more durable closure of AGF with the utilization of covered metallic stents and when the fistula is bronchial in origin. Despite a high recurrence rate (39%), stenting may provide temporization until surgery can be tolerated. Airway stenting for AGF should not be considered as a definitive therapy and when utilized it requires frequent reassessment for recurrence.

Airway gastric fistula after esophagectomy for esophageal cancer

Airway gastric fistula formation is a rare and complex complication after esophagectomy. Clinical presentations vary, making a uniform approach to treatment not possible. Recently, nonsurgical approaches have been reported using various types of airway stents. However, the usefulness of airway stenting in the treatment of airway gastric fistula is relatively unknown. We present a patient with hemoptysis, respiratory failure, and an enlarging left mainstem bronchogastric fistula after esophagectomy. The patient's symptoms were temporized by the placement of a silicone stent.

Pulmonary-gastric fistula

Pulmonary to gastric fistulae are extremely rare. They can occur secondary to infection or malignancy invading through the lung into the pleural space, through the diaphragm and into the stomach. The case history reports on the successful diagnosis and treatment of a pulmonary to gastric fistula.

Gastrobronchial fistula as a rare complication of gastroplasty for obesity: a report of two cases

Gastrobronchial fistula is a rare condition as a complication following bariatric surgery. The management of this condition requires the active participation of a pulmonologist, who should be familiar with aspects of the main types of bariatric surgery. Herein, we report the cases of two patients who presented recurrent subphrenic and lung abscess secondary to fistula at the angle of His for an average of 19.5 months. After relaparotomy was unsuccessful, cure was achieved by antibiotic therapy and, more importantly, by stenostomy and endoscopic dilatation, together with the use of clips and fibrin glue in the fistula. These pulmonary complications should not be treated in isolation without a gastrointestinal evaluation since this can result in worsening of the respiratory condition, thus making anesthetic management difficult during endoscopic procedures.

Successful conservative management of benign gastro-bronchial fistula after intrathoracic esophagogastrostomy

Benign gastro-bronchial fistula is a rare and devastating complication of esophagectomy with gastric replacement. The most likely cause is a leak from the esophagogastric anastomosis with subsequent mediastinal abscess and rupture into the posterior wall of the tracheobronchial tree. The clinical presentation includes cough upon swallowing, fever, and recurrent pneumonia. Early surgical treatment is the standard of care. A unique case of chronic gastro-bronchial fistula is reported in this article. The patient, a 57-year-old woman, was referred from another hospital after 6 months of symptomatic therapy and total enteral nutrition. A self-expanding esophageal metal stent allowed exclusion of the fistula with symptom relief and return to oral alimentation.

Gastrotracheal and gastrobronchial fistulas: management with covered expandable metallic stents

PURPOSE

The present study evaluated the clinical results of covered tracheobronchial metallic stent placement in the management of gastrotracheal fistulas (GTFs) and gastrobronchial fistulas (GBFs).

MATERIALS AND METHODS

Sixteen patients with GTFs or GBFs after esophagogastrectomy were treated with one of two types of covered tracheobronchial metallic stents: a hinged stent or a straight stent. These included 12 GTFs and four GBFs. Thirteen hinged stents and three straight stents were placed during the initial procedure. Data regarding the technical success of stent placement, initial clinical success and failure, fistula reopening, and complications were obtained.

RESULTS

Stent placement was technically successful in all patients. The stent completely sealed off the fistula in 12 of 16 patients (75% initial clinical success rate), whereas the remaining four patients (25%) had persistent aspiration symptoms as a result of incomplete GTF or GBF closure (ie, initial clinical failure). During follow-up, the fistula reopened in three of the 12 patients in whom initial clinical success was achieved (25%). Two reopened fistulas were sealed off with stent placement, and one was treated with a nasoenteric feeding tube and a nasogastric decompression tube. All patients died during the 1-year follow-up period; mean survival time was 17 +/- 3.02 weeks (range, 1-42 weeks) after stent placement. Mean survival in patients in whom initial clinical success was achieved was significantly longer than in patients with initial clinical failure (P = .003; log-rank test).

CONCLUSION

Use of covered metallic stents appears to be a safe and moderately effective procedure to occlude GTFs and GBFs.

Benign gastro-bronchial fistula - an uncommon complication of esophagectomy: case report

Background

Gastro-bronchial fistula (GBF) is a rare and devastating complication following esophagectomy. Making the correct diagnosis is difficult and there is no agreement on the treatment for this rare condition.

Case presentation

We report the case of a 56-year-old man who presented with features of repeated aspiration and chest infections six years following an esophagectomy for Barrett's esophagus. Despite extensive investigations the cause of symptoms was difficult to determine. The correct diagnosis of fistula from stomach to right main stem bronchus was made at bronchoscopy under general anesthesia. After ruling out local recurrence of cancer, a successful primary repair was carried out by resection of fistula and direct repair of gastric conduit and bronchus. He is well after 6 months of treatment.

Conclusion

Late development of gastro-bronchial fistula is a rare complication of esophageal resection that may be difficult to diagnose.

Surgical resection and direct closure is the treatment of choice, although the method of treatment should be tailored according to the anatomy of the fistula and the patient's condition.