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Schreder T, Borbély Y, Christen S, Wiest R, Räber L, Günther G. Long-term outcome following successful endoscopic closure of tracheo-oesophageal fistulas with two cardiac amplatzer septal occluders in a patient with oesophageal cancer. Respirol Case Rep 2024; 12:e01244. [PMID: 38045823 PMCID: PMC10687588 DOI: 10.1002/rcr2.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Acquired tracheo-oesophageal fistulas (TEFs) are rare and challenging complications in the course of oesophageal cancer. While surgery is the only curative treatment option for TEFs many patients are not eligible for surgery. Endoscopic treatment approaches such as tracheal- and/or oesophageal- stenting are available, but associated with complications like the development of new fistulas and mucus retention. Off- label-use of cardiac amplatzer occluder devices to close TEFs has been reported in few case-reports with inconsistent short-term outcomes. We report a case of successful closure of two adjacent TEFs with two partially overlapping cardiac amplatzer occluder devices. The insertion of a 12 mm and a 9 mm device was successful and without complications. The patient tolerated the cardiac amplatzer-devices well and could resume oral food uptake after 2 months. Two years after closure, the patient remained free of symptoms suggesting complete sealing of the fistulas.
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Affiliation(s)
- Theresa Schreder
- Department of Pulmonary Medicine and Allergology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Yves Borbély
- Department of Visceral Surgery and Medicine, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Stefan Christen
- Department of Visceral Surgery and Medicine, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Reiner Wiest
- Department of Visceral Surgery and Medicine, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Lorenz Räber
- Department of Cardiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Gunar Günther
- Department of Pulmonary Medicine and Allergology, InselspitalBern University Hospital, University of BernBernSwitzerland
- Department of Human and Translational Medicine, School of MedicineUniversity of NamibiaWindhoekNamibia
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Shawky MA, Shawky MA, Zakaria Zakaria N. Incidence of Airway Complications in ICU. Indian J Otolaryngol Head Neck Surg 2023; 75:2752-2759. [PMID: 37974766 PMCID: PMC10645749 DOI: 10.1007/s12070-023-03850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 11/19/2023] Open
Abstract
To show the incidence of airway complications in ICU. Endotracheal intubation is an essential skill performed by multiple medical specialists to secure a patient's airway as well as provide oxygenation and ventilation through the oral route or nose. The goal of endotracheal intubation in the emergency setting is to secure the patient's airway and obtain first-pass success. There are many indications for endotracheal intubation, including poor respiratory drive, questionable airway patency, hypoxia, and Hypercapnia. These indications are assessed by evaluating the patient's mental status, conditions that may compromise the airway, level of consciousness, respiratory rate, respiratory acidosis, and level of oxygenation. In the setting of trauma, a Glasgow Coma Scale of 8 or less is generally an indication for intubation. There are many different complications of intubation as hoarseness of voice, dental injuries, arytenoid dislocation, laryngeal stenosis, tracheal stenosis and tracheomalacia. . 150 patients who were sat in the ICU that developed certain complications. 86 patients (57.3%) were sitting in the ICU develoed certain complications. Liver diseases were the main cause of ICU admission 34 (22.7%) patients then shock 32 (21.3%) patients. Blockage of endotracheal tube was the main ICU complications 18 (12%) patients then sinusitis 16 (10.7%) patients. Endotracheal intubation is a lifesaving procedure and its complications are significant problems in ICUs. A successful procedure of intubation avoids complications. Skilled endotracheal intubation in the ICU decreases the complications.
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Engel-Rodriguez A, Tiru-Vega M, Merced-Roman J, Fonseca-Ferrer V, Engel-Rodriguez N, Otero-Dominguez Y, Rodriguez-Cintron W. Diagnosis and Management of a Massive Eight-Centimeter Acquired Tracheoesophageal Fistula. Cureus 2023; 15:e43689. [PMID: 37724200 PMCID: PMC10505277 DOI: 10.7759/cureus.43689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Here, we present the case of a 61-year-old veteran Hispanic male with recurrent aspiration pneumonitis, aerophagia, tympanic abdominal bloating, and a positive Ono's sign; symptoms present were secondary to diagnosed tracheoesophageal fistulas (TEFs). TEFs are abnormal connections between the esophagus and the trachea. In adult cases, several risk factors have been identified for acquired cases, which include infection, trauma, and cancer. Diagnosis of TEF can be challenging and, in most cases, requires high suspicion. Currently, there are no established guidelines for diagnosing and managing TEF. Clinical assessment and various imaging techniques are essential in the diagnostic process. This article will discuss the etiology, clinical presentation, diagnostic approaches, and management options for acquired TEFs.
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Affiliation(s)
| | - Marilee Tiru-Vega
- Internal Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - Jesus Merced-Roman
- Internal Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - Vanessa Fonseca-Ferrer
- Pulmonology and Critical Care, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | | | - Yomayra Otero-Dominguez
- Pulmonary and Critical Care Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - William Rodriguez-Cintron
- Pulmonary and Critical Care Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
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Kamaleddine I, Hendricks A, Popova M, Schafmayer C. Adequate Management of Postoperative Complications after Esophagectomy: A Cornerstone for a Positive Outcome. Cancers (Basel) 2022; 14. [PMID: 36428649 DOI: 10.3390/cancers14225556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Esophagectomy for cancer is one of the most complex procedures in visceral surgery. Postoperative complications negatively affect the patient's overall survival. They are not influenced by the histology type (adenocarcinoma (AC)/squamous cell carcinoma (SCC)), or the surgical approach (open, laparoscopic, or robotic-assisted). Among those dreadful complications are anastomotic leak (AL), esophago-respiratory fistula (ERF), and chylothorax (CT). METHODS In this review, we summarize the methods to avoid these complications, the diagnostic approach, and new therapeutic strategies. RESULTS In the last 20 years, both centralization of the medical care, and the development of endoscopy and radiology have positively influenced the management of postoperative complications. For the purpose of their prevention, perioperative measures have been applied. The treatment includes conservative, endoscopic, and surgical approaches. CONCLUSIONS Post-esophagectomy complications are common. Prevention measures should be known. Early recognition and adequate treatment of these complications save lives and lead to better outcomes.
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Abstract
Esophageal diverticulum with secondary bronchoesophageal fistula is a rare clinical entity that manifests as respiratory infections, coughing during eating or drinking, hemoptysis, and sometimes fatal complications. In the present study, we describe a case of bronchoesophageal fistula emanating from esophageal diverticulum in a 45-year-old man who presented with bronchiectasis. We summarize the characteristics of this rare condition based on a review of the relevant literature.
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Affiliation(s)
- Xiaolin Zhang
- Department of Geriatrics, 26447Peking University First Hospital, Beijing, China
| | - Hongmei Jiao
- Department of Geriatrics, 26447Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- Department of Geriatrics, 26447Peking University First Hospital, Beijing, China
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Chen Y, Zhou Z, Feng J, Zhong C, Lu L, Chen X, Tang C, Li S. [Use of Hybrid Stent in Management of Complex Malignant Airway Stenosisand Fistulas]. Zhongguo Fei Ai Za Zhi 2021; 23:472-478. [PMID: 32517452 PMCID: PMC7309543 DOI: 10.3779/j.issn.1009-3419.2020.104.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
背景与目的 气道内支架广泛应用于气管狭窄和气管瘘的治疗,但使用气道内支架重建复杂气道的临床数据仍不充足。硅酮支架杂交金属支架重建复杂气道的有效性和安全性。 方法 纳入无法手术的复杂恶性气道狭窄和气道瘘患者。使用Y型硅酮支架联合金属覆膜支架(杂交支架)重建气道。评价置入支架后6个月的疗效和并发症。 结果 共纳入23例患者,置入23枚Y型硅酮支架和25枚金属覆膜支架。19例患者(19/23, 82.6%)置入支架后症状迅速缓解。支架平均置入(153.43±9.14)d。置入支架后改良呼吸困难指数(modified British Medical Research Council, mMRC)、卡氏功能状态(Karnofsky performance status, KPS)评分和功能状态(performance status, PS)评分显著改善。12例患者带支架生存超过6个月。其余患者肿瘤进展导致6个月内死亡。无支架置入相关死亡及严重并发症。 结论 杂交支架重建恶性复杂气道疗效确切,耐受良好。
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Affiliation(s)
- Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Ziqing Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jiaxin Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Changhao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Liya Lu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaobo Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Chunli Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute ofRespiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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De Moura DTH, Baptista A, Jirapinyo P, De Moura EGH, Thompson C. Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review. Clin Endosc 2020; 53:37-48. [PMID: 31286746 PMCID: PMC7003006 DOI: 10.5946/ce.2019.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 02/06/2023] Open
Abstract
Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopic approaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported. We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. The primary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management. A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved in all cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was 22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the success of closure and adverse events in relation to several variables among the subgroups. The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived from this sparse literature suggest that it can be an option in the management of GI fistulas.
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Affiliation(s)
- Diogo Turiani Hourneaux De Moura
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Alberto Baptista
- Hospital das Clínicas Caracas, Unidad de Exploraciones Digestivas, Caracas, Venezuela
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Baptista A, Hourneaux De Moura DT, Jirapinyo P, Hourneaux De Moura EG, Gelrud A, Kahaleh M, Salinas A, Sabagh LC, Ospina A, Rincones VZ, Doval R, Bandel JW, Thompson CC. Efficacy of the cardiac septal occluder in the treatment of post-bariatric surgery leaks and fistulas. Gastrointest Endosc 2019; 89:671-679.e1. [PMID: 30529441 DOI: 10.1016/j.gie.2018.11.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopy has evolved to become first-line therapy for the treatment of post-bariatric leaks; however, many sessions are often required with variable success rates. Due to these limitations, the use of the cardiac septal defect occluder (CSDO) has recently been reported in this population. METHODS The study population was a multicenter retrospective series of patients with post-bariatric surgical leaks who underwent treatment with CSDO placement. Data on the type of surgery, previous treatment details, fistula dimensions, success rate, and adverse events were collected. Leaks were grouped according to the International Sleeve Gastrectomy Expert Panel Consensus. Outcomes included technical and clinical success and safety of the CSDO. Regression analysis was performed to determine the predictors of response. RESULTS Forty-three patients with leaks were included (31 sleeve gastrectomy and 12 Roux-en-Y gastric bypass). They were divided into acute (n = 3), early (n = 5), late (n = 23), and chronic (n = 12). Forty patients had failed previous endoscopic treatment and 3 patients had CSDO as the primary treatment. Median follow-up was 34 weeks. Technical success was achieved in all patients and clinical success in 39 patients (90.7%). All chronic, late, and early leaks were successfully closed, except one undrained late leak. The 5 patients with early leaks had an initial satisfactory response, but within 30 days, drainage recurred. The CSDOs were removed and replaced with larger-diameter devices leading to permanent defect closure. Acute leaks were not successfully closed in all 3 patients. Regression analysis showed that chronicity and previous treatment were associated with fistula closure; success rates for late/chronic leaks versus acute/early leaks were 97.1% and 62.5%, respectively (P = .0023). CONCLUSION This observational study found that the CSDO had a high efficacy rate in patients with non-acute leaks, with no adverse events. All early, late, and chronic leaks were successfully closed, except for one undrained late leak. However, early leaks required a second placement of a larger CSDO in all cases. These results suggest that the CSDO should be considered for non-acute fistula and that traditional closure methods are likely preferred in the acute and early settings.
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Affiliation(s)
- Alberto Baptista
- Hospital das Clínicas Caracas, Unidad de Exploraciones Digestivas, Caracas, Venezuela
| | - Diogo Turiani Hourneaux De Moura
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pichamol Jirapinyo
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Alberto Salinas
- Hospital das Clínicas Caracas, Unidad de Exploraciones Digestivas, Caracas, Venezuela
| | | | | | | | - Raul Doval
- Centro Médico de Caracas, Caracas, Venezuela
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