Benign esophagobronchial fistula with and without esophageal obstruction: two ends of the surgical spectrum

Acquired esophagobronchial fistula without Ono's sign and with unusual cause

A 60-year-old woman presented with dyspnoea and respirophasic chest discomfort, as well as a history of idiopathic oesophageal diverticulum. Physical examinations showed no evidence of Ono's sign, fever and weight loss. Chest radiograph revealed a right-sided transudative pleural effusion. Barium oesophagogram made a diagnosis of acquired esophagobronchial fistula communicating between oesophagus and bronchus. The oesophagobronchial fistula, causing pleural effusions, was very small and could be caused by idiopathic oesophageal diverticulum. The pleural effusion was removed by thoracentesis, which improved her symptoms. Surgical therapy or covered oesophageal stenting was advised, but she declined. She is followed-up regularly on an outpatient basis.

Benign bronchoesophageal fistula in adults: endoscopic closure as primary treatment

BACKGROUND/AIMS

Benign bronchoesophageal fistula (BEF) is a rare condition that is usually treated surgically; however, less invasive endoscopy procedures have been attempted to overcome the disadvantages of surgery. The aim of this study was thus to determine the results of endoscopic management as a primary treatment in patients with BEF.

METHODS

We retrospectively analyzed data from 368 patients with BEF who were treated at a tertiary care, academic medical center between January 2000 and August 2009.

RESULTS

Benign causes were found for only 18 of the 368 patients. Of these, seven were treated endoscopically and the others by surgery or other methods. The first endoscopy procedures failed in all seven patients, with second trials of endoscopy performed in four patients at a median of 8 days (range, 3 to 11 days) after the first procedure. The second endoscopic procedure was successful in two out of four patients; one patient showed no recurrence of the fistula, whereas the second patient experienced a recurrence after 24 months. All patients underwent successful surgical procedures after the failure of endoscopic treatment, with no further recurrences.

CONCLUSIONS

Although we observed a low rate of success for primary endoscopic treatment of benign BEF, the invasive nature of surgery suggests the need for a prospective study with a large number of patients to evaluate the efficacy of less invasive procedures such as endoscopic treatment.