Endoscopic management of gastro‐bronchial fistula following two‐stage esophagectomy using over‐the‐scope‐clip (OTSC): Case series

Abstract Background Post-oesophagectomy gastro-bronchial fistula (GBF) has significant morbidity and mortality. Management of GBF remains non-standardized due its rarity and limited available evidence. Re-operation and surgical repair has been the main approach. More recently, multimodal endoscopic treatment is gaining popularity as primary treatment option due to its relatively non-invasiveness, increasing evidence of success rate and reduced morbidity. We present a case series of GBF managed endoscopically using over-the-scope-clip (OTSC). Methods A dedicated, prospective and contemporaneous regional Upper GI cancer database was searched to identify GBF from January 2015 to December 2017. Clinical notes and investigation images of identified cases were analysed. Results Three patients developed post-oesophagectomy GBF during study period. Mean age of patients was 53. Mean time of GBF diagnosis was 233 days (range: 20–608). Two patients had endoscopic stent placement prior to OTSC application. Primary technical success was achieved in all patients. No adverse events were reported. Two patients had complete healing of GBF and mean healing time was 15 days (range: 6–24). One patient who had significant co-morbidities (peripheral arterial disease, diabetes, hepatitis C, rheumatoid arthritis and heavy smoker) developed persistent leak of GBF and died from cardiac event. Conclusion GBF and its surgical treatment are associated with a high morbidity and mortality. We present this case series where two out of three patients with GBF were successfully treated with this modality. Endoscopic therapy incorporating OTSC placement is a feasible option in management of post-oesophagectomy GBF. Further studies are required to understand and establish its role in treatment algorithm of post-oesophagectomy GBF. Disclosure All authors have declared no conflicts of interest.

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Closure of Gastrointestinal Fistulas and Leaks with the Over-the-Scope Clip: Case-Series Analysis

Indian Journal of Surgery ◽

10.1007/s12262-020-02714-w ◽

2021 ◽

Author(s):

Abdullah Senlikci ◽

Tahsin Dalgic ◽

Ahmet Alyanak ◽

Erdal Birol Bostanci

Keyword(s):

Case Series ◽

Series Analysis ◽

Over The Scope Clip

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Mo1986 Endoscopic Management of Refractory Gastric Antral Vascular Ectasia (GAVE) With Cryoballoon Therapy: A Case Series

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.1173 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB507-AB508

Author(s):

Anish Patel ◽

Amit H. Sachdev ◽

Prashant Mudireddy ◽

Shaffer Mok ◽

Nadia Ansari ◽

...

Keyword(s):

Case Series ◽

Endoscopic Management ◽

Gastric Antral Vascular Ectasia ◽

Vascular Ectasia

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Case series: Endoscopic management of fourth branchial arch anomalies

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2013.02.007 ◽

2013 ◽

Vol 77 (5) ◽

pp. 766-769 ◽

Cited By ~ 26

Author(s):

G.J. Watson ◽

J.R. Nichani ◽

M.P. Rothera ◽

I.A. Bruce

Keyword(s):

Case Series ◽

Branchial Arch ◽

Endoscopic Management

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Endoscopic management of paediatric meningoencephaloceles: a case series

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-018-5116-z ◽

2018 ◽

Vol 275 (11) ◽

pp. 2727-2731 ◽

Cited By ~ 2

Author(s):

M. Stavrakas ◽

P. D. Karkos ◽

S. Triaridis ◽

J. Constantinidis

Keyword(s):

Case Series ◽

Endoscopic Management

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Erratum to: Endoscopic Management of Double Esophageal Perforation by Ingested Foreign Body Using Over-the-Scope Clip: A Case Report

Journal of Digestive Endoscopy ◽

10.1055/s-0040-1716461 ◽

2020 ◽

Vol 11 (02) ◽

pp. e1-e1

Author(s):

Prasanta Debnath ◽

Pravin Rathi ◽

Sujit Nair ◽

Suhas Udgirkar ◽

Sanjay Chandnani ◽

...

Keyword(s):

Case Report ◽

Foreign Body ◽

Esophageal Perforation ◽

Endoscopic Management ◽

Ingested Foreign Body ◽

Over The Scope Clip

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Endoscopic Treament of Luminal Perforations and Fistulae with an Over-the-Scope Clip: A Case Series and Novel Application

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-01500 ◽

2016 ◽

Vol 111 ◽

pp. S687

Author(s):

Linsey Spence ◽

Leybelis Padilla ◽

Andrew Dries

Keyword(s):

Case Series ◽

Over The Scope Clip

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Endoscopic Management of Spontaneous Clival Cerebrospinal Fluid Leaks: Case Series and Literature Review

World Neurosurgery ◽

10.1016/j.wneu.2015.11.026 ◽

2016 ◽

Vol 86 ◽

pp. 470-477 ◽

Cited By ~ 7

Author(s):

Fabio Pagella ◽

Alessandro Pusateri ◽

Elina Matti ◽

Cesare Zoia ◽

Marco Benazzo ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Literature Review ◽

Case Series ◽

Endoscopic Management ◽

Cerebrospinal Fluid Leaks

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KTP-laser–Assisted Endoscopic Management of Glomus Tympanicum Tumors: A Case Series

Ear Nose & Throat Journal ◽

10.1177/014556131809701209 ◽

2018 ◽

Vol 97 (12) ◽

pp. 399-402 ◽

Cited By ~ 2

Author(s):

Julia E. Noel ◽

Hamed Sajjadi

Keyword(s):

Case Series ◽

Feeding Tube ◽

Vascular Supply ◽

Endoscopic Management ◽

Suction Catheter ◽

Ktp Laser ◽

Ear Canal ◽

Glomus Tympanicum ◽

Hearing Outcomes

Endoscopic technology is widely used in rhinology and anterior skull base surgery, but it has been less quickly incorporated into otologic practice. The design of the instrumentation forces surgeons to work one-handed and limits depth perception. Nevertheless, endoscopy also offers wide fields of view and access to spaces that are typically difficult to visualize. Its advantages have broadened the type and extent of operations that can be performed via the ear canal. We describe a method of endoscopic resection of glomus tympanicum tumors in 5 adults who had undergone endoscopic or endoscopyassisted resection. A successful resection was achieved in all patients—exclusively via the ear canal in 4 of them. A KTP laser was used to address the tumor's vascular supply. Attachment of a neonatal feeding tube to the endoscope for use as a suction catheter obviated the need to repeatedly switch instruments while using the laser. At a minimum of 12 months of follow-up, all patients were free of recurrence. Postoperative audiometry detected no significant adverse hearing outcomes in any patient. We conclude that the minimally invasive endoscopic transcanal approach is a feasible technique for addressing middle ear tumors. We have also developed a method that allows surgeons constant use of the KTP laser to resect a glomus tympanicum tumor.

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Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01307-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zanxin Wang ◽

Xianmian Zhuang ◽

Bailang Chen ◽

Junmin Wen ◽

Minxin Wei

Keyword(s):

False Lumen ◽

Case Series ◽

Celiac Artery ◽

True Lumen ◽

Elephant Trunk ◽

Two Stage ◽

Aortic Repair ◽

Initial Surgery ◽

Cord Injury

Abstract Background The present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion. Methods This retrospective case series included 20 patients with Stanford A dissection administered two-stage thoracic endovascular aortic repair (TEVAR) about 1 month after central repair because of visceral or limb malperfusion. The patients were examined by computed tomography (CT) angiography at 3, 6, 12 and 24 months after operation. Recovery of malperfusion and true lumen index were evaluated during follow-up. Results Twenty patients underwent two-stage hybrid aortic repair, including 11 males and 9 females. The follow-up time was 24 ± 7 months. No intervention-related complications were observed, including stent graft-induced new re-entry tears, death, stroke and spinal cord injury. Malperfusion in all cases was corrected. The true lumen was not enlarged enough 1 month after the first surgery. Thrombosis of the false lumen was observed around the elephant trunk at the carina level and the celiac artery. Three months after second stage TEVAR, the false lumen thrombosis was resorbed; in addition, the trunk was fully expanded at the carina level, and the true lumen was enlarged at the celiac artery. Conclusions Two-stage hybrid aortic repair for residual true lumen in the distal aorta 1 month after initial surgery is helpful for descending aorta remodeling and effective in treating malperfusion. This procedure may be a good option for patients suffering from Stanford A dissection with small true lumen in the distal aorta and malperfusion.

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