Clinical Endoscopy

Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer: Iatagan R. Josino, Bruno C. Martins, Andressa A. Machado, Gustavo R. de A. Lima, Martin A. C. Cordero, Amanda A. M. Pombo, Rubens A. A. Sallum, Ulysses Ribeiro Jr, Todd H. Baron, Fauze Maluf-Filho; Clin Endosc 2023;56(6):761-768. Published online July 25, 2023; DOI: https://doi.org/10.5946/ce.2022.297

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Background
/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer.
Methods
This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study.
Results
Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival.
Conclusions
The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

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Clinical Implications of Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma: Cancer-Draining Blood Versus Peripheral Blood
Dong Chan Joo, Gwang Ha Kim, Hoseok I, Su Jin Park, Moon Won Lee, Bong Eun Lee
Cancers.2024; 16(16): 2921. CrossRef
How to reduce fistula formation after self-expandable metallic stent insertion for treating malignant esophageal stricture?
Kwang Bum Cho
Clinical Endoscopy.2023; 56(6): 735. CrossRef

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Successful Closure of a Benign Refractory Tracheoesophageal Fistula Using an Over-the-Scope Clip after Failed Esophageal Stent Placement and Surgical Management: Nonthalee Pausawasdi, Chotirot Angkurawaranon, Tanyaporn Chantarojanasiri, Arunchai Chang, Wanchai Wongkornrat, Somchai Leelakusolvong, Asada Methasate; Clin Endosc 2020;53(3):361-365. Published online October 28, 2019; DOI: https://doi.org/10.5946/ce.2019.106

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Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.

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Endoscopic closure of tracheoesophageal fistula using a novel over-the-scope-clip
Qi Gong, Aihong Yin, Zhi Wei
Asian Journal of Surgery.2024;[Epub] CrossRef
Successful Closure of a Tracheoesophageal Fistula Using an Over-The-Scope Clip
Osman Ali, Gurbani Singh, Sindhura Kolachana, Mohammed a Khan, Varun Kesar
Cureus.2023;[Epub] CrossRef
Over-the-Scope Clip Closure of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Tube Removal: A Report of Two Cases
Shigenori Masaki, Keishi Yamada
Cureus.2021;[Epub] CrossRef
Over-the-Scope Clip-Associated Endoscopic Muscular Dissection for Seven Cases of Small Gastric Submucosal Tumor: A Video-Based Case Series
Xin Li, Rongfen Wei, Jianfu Qin, Fei Qin, Peng Peng, Mengbin Qin, Shiquan Liu, Jiean Huang, Piero Chirletti
Gastroenterology Research and Practice.2021; 2021: 1. CrossRef

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Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor: Dongwuk Kim, Juwon Kim, Daegeun Lee, Ha Sung Chang, Hyunsung Joh, Won-Jung Koh, Jun Haeng Lee; Clin Endosc 2016;49(6):564-569. Published online April 18, 2016; DOI: https://doi.org/10.5946/ce.2016.020

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Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistant tuberculosis (MDR-TB). Herein, we report the case of a 61-year-old woman who visited a local hospital complaining of odynophagia. An initial esophagogastroduodenoscopy revealed an esophageal submucosal tumor, and subsequent chest computed tomography showed subcarinal lymphadenopathy with an esophagomediastinal fistula. The patient was then referred to Samsung Medical Center, and a second esophagogastroduodenoscopy showed deep central ulceration, as well as a suspicious fistula in the esophageal submucosal tumor-like lesion. A biopsy examination of the ulcerative lesion confirmed focal inflammation only. Next, an endobronchial, ultrasound-guided lymph node biopsy was performed, and TB was confirmed. The patient initially began a course of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, after a drug sensitivity test, she was diagnosed with MDR-TB, and second-line anti-TB medications were prescribed. She recovered well subsequently.

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Detection of Esophageal Tuberculosis, a Rare Cause of Abdominal Pain, on18F-FDG PET/CT
Tarun Kumar Jain, Hemant Malhotra, Subhash Nepalia, Ganesh Narayan Saxena
Journal of Nuclear Medicine Technology.2024; 52(2): 179. CrossRef
Esophagomediastinal fistula secondary to tuberculous mediastinal lymphadenopathy
Ming-Dong Zhou, Dong-Ge Han, Wei Liu
Clinics and Research in Hepatology and Gastroenterology.2023; 47(10): 102243. CrossRef
“Esophagomediastinal fistula presenting as drug resistant tuberculosis”
Chinnu Sasikumar, Ketaki Utpat, Unnati Desai, Jyotsna M. Joshi
Indian Journal of Tuberculosis.2020; 67(3): 363. CrossRef
Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report
Sultan R Alharbi
World Journal of Gastroenterology.2019; 25(17): 2144. CrossRef
Combined transbronchoscopic needle aspiration (TBNA) and rapid on-site cytological evaluation (ROSE) for diagnosis of tuberculous mediastinal lymphadenitis
Xi Dai, Bin Niu, Xiao-Qiong Yang, Guo-Ping Li
Medicine.2018; 97(37): e11724. CrossRef
Mediastinal Tuberculous Lymphadenitis Diagnosed by Endosonographic Fine Needle Aspiration
Joonhwan Kim, Youngwoo Jang, Kyung Oh Kim, Yoon Jae Kim, Dong Kyun Park, Dong Hae Chung, Eun Young Kim, Jun-Won Chung
The Korean Journal of Gastroenterology.2016; 68(6): 312. CrossRef

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Communicating Tubular Esophageal Duplication Combined with Bronchoesophageal Fistula: Ju Hwan Kim, Chang-Il Kwon, Ji Young Rho, Sang Woo Han, Ji Su Kim, Suk Pyo Shin, Ga Won Song, Ki Baik Hahm; Clin Endosc 2016;49(1):81-85. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.81

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Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF.

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Reconstruction of Adult Tubular Esophageal Duplication with Supraclavicular Artery Island Flap: A Rare Case Presentation
Xin Yang, Zheng Jiang, Jun Liu, Fei Chen
Ear, Nose & Throat Journal.2023; : 014556132311734. CrossRef
Tubular Duplication of the Esophagus in a Newborn, Treated by Thoracoscopy
Igor Khvorostov, Alexey Gusev, Abdumanap Alkhasov, Sergey Yatsyk, Elena D'yakonova
European Journal of Pediatric Surgery Reports.2022; 10(01): e49. CrossRef
Endoscopic septum division of tubular esophageal duplication in two children and systematic review
Rahşan Özcan, Ali Ekber Hakalmaz, Şenol Emre, Ayşe Karagöz, Çiğdem Tütüncü, Sebuh Kuruğoğlu, Gonca Topuzlu Tekant
Pediatric Surgery International.2022; 38(11): 1525. CrossRef
Endoscopic management of a tubular esophageal duplication in a young adult
Pietro Familiari, Rosario Landi, Francesca Mangiola, Camilla Vittoria Vita, Guido Costamagna
VideoGIE.2020; 5(10): 455. CrossRef
Esophageal duplication and congenital esophageal stenosis
A. Francois Trappey, Shinjiro Hirose
Seminars in Pediatric Surgery.2017; 26(2): 78. CrossRef

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A Case of Aortoesophageal Fistula Complicated by a Stent for Benign Esophageal Stricture: Ja Won Kim, M.D., Sung Jo Bang, M.D., Do Ha Kim, M.D., Hee Chul Jung, M.D., Ssang Yong Oh, M.D., Sang Jin Lee, M.D., Ji Eun Lee, M.D. and Jeong Hoon Lee, M.D.; Korean J Gastrointest Endosc 2010;40(6):357-360. Published online June 30, 2010

Abstract PDF: Self-expandable metallic stents (SEMS) are widely used for the palliative treatment of malignant strictures of the gastrointestinal tract. Recently, several studies tested whether a SEMS is an effective and safe option for benign esophageal stricture. 　Serious complications such as hemorrhage, compression of the bronchus, bronchoesophageal fistula, and esophageal rupture were infrequently encountered as complications of esophageal stent placement. Aortoesophageal fistula is extremely rare as a complication of esophageal SEMS insertion; only seven cases have been reported worldwide. We now report a case of an 80-year old female with aortoesophageal fistula after placement of a SEMS for an esophageal stricture. (Korean J Gastrointest Endosc 2010;40:357-360)

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A Case of Broncho-esophageal Fistula Treated by Histoacryl^Ⓡ Injection Therapy: Kun Hyung Cho, M.D., Jee Hyun Park, M.D., In Du Jeong, M.D., Byeong Mahn Lee, M.D., Dong In Kim, M.D., Jin Woo Lee, M.D., Young Chul Jo, M.D., Jae Cheol Hwang, M.D.*, Dae-Hyun Kim, M.D.^† and Do Ha Kim, M.D.; Korean J Gastrointest Endosc 2005;31(3):161-165. Published online September 30, 2005

Abstract PDF: Broncho-esophageal fistula is a disease of varying etiologies. Spontaneous fistula occurs as a result of malignancy, radiotherapy or inflammatory disease. The majority of fistulas are caused by iatrogenic causes. Treatment of fistula usually consists of surgery and conservative management. Recently, it has been reported that broncho-esophageal fistula can be treated endoscopically using tissue adhesive agent such as Histoacryl^Ⱂ and fibrin glue. We report a case of broncho-esophageal fistula as a complication of tuberculosis that was successfully treated by radiological Histoacryl^Ⱂ injection therapy with a review of literatures. (Korean J Gastrointest Endosc 2005;31:161⁣165)

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A Case of Broncho-esophageal Fistula Treated by Histoacryl^Ⓡ Injection Therapy: Kun Hyung Cho, M.D., Jee Hyun Park, M.D., In Du Jeong, M.D., Byeong Mahn Lee, M.D., Dong In Kim, M.D., Jin Woo Lee, M.D., Young Chul Jo, M.D., Jae Cheol Hwang, M.D.*, Dae-Hyun Kim, M.D.^† and Do Ha Kim, M.D.; Korean J Gastrointest Endosc 2005;31(3):161-165. Published online September 30, 2005

Abstract PDF: Broncho-esophageal fistula is a disease of varying etiologies. Spontaneous fistula occurs as a result of malignancy, radiotherapy or inflammatory disease. The majority of fistulas are caused by iatrogenic causes. Treatment of fistula usually consists of surgery and conservative management. Recently, it has been reported that broncho-esophageal fistula can be treated endoscopically using tissue adhesive agent such as Histoacryl^Ⱂ and fibrin glue. We report a case of broncho-esophageal fistula as a complication of tuberculosis that was successfully treated by radiological Histoacryl^Ⱂ injection therapy with a review of literatures. (Korean J Gastrointest Endosc 2005;31:161⁣165)

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증례 : 식도 위장관 ; 인공식도관 삽입으로 치료한 결핵에 의한 식도-기관지누공 환자 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Tuberculous Esophagorespiratory Fistula Managed by Silicone - Covered Self - Expendable Metal Stent ): Korean J Gastrointest Endosc 1998;18(1):66-70. Published online November 30, 1997

Abstract PDF: Esophagorespiratory fistulas resulting from Mycobacterium tuberculosis infection are rare. Whereas most esophagorespiratory fistulas are absolute indication for direct surgical closure, this may not be necessary in the case of those of tuberculous origin. If diagnosed early, the infection and the complicating fistula could be treated effectively with anti- tuberculous chemotherapy without the need for surgical intervention. Despite the sugges- tion of a trend away from direct surgical closure in recent years, it seems that anti tuberculous chemotherapy may not result in healing of the fistula in all patients. So we report a case of tuberculous esophagorespiratory fistula that has severe aspiration pneumorua and effectively treated with implantation of silicone-covered self-expandable metal stent and antituberculous chemotherapy. (Karean J Gastrointest Endosc 18: 66- 70, 1998)

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증례 : 식도 위장관 ; 생선뼈에 의해 형성된 기관 식도루에서 Fibrinogen - thrombin glue 로 치유된 기관 식도루 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Tracheoesophageal Fistula Caused by Fish Bone Induced Trauma with Complete Healing by Using the Fibrinogen - thrombin Glue ): Korean J Gastrointest Endosc 1997;17(1):49-54. Published online November 30, 1996

Abstract PDF: Tracheoesophageal fistula is a rare disease of abnormal communication between esopha- gus and respiratory system. The common causes are the acquired origins in adult such as trauma, infection of the adjacent organs, malignant tumor, and foreign body. Among the traumatic origins, chemical drug, the procedure of the dilatation on the stenotic area, blunt trauma(fall, collisions), penetrating trauma(bullet, knife), and pressure injury are much more common than others. Recently, trauma and foreign body in the esophagus and bronchus are becoming the main cause of the tracheoesophageal fistula, however the frequency of the development of tracheoesophageal fistula caused by the infectious diseases is getting decreased. Fibrinogen-thrombin glue stimulates the healing process of the wound and the ulcer. We treated a 52-year-old male patient with nan-inalignant tracheoesophageal fistula, who had symtoms of pharyngolaryngeal and chest discomfort concomitant with a paroxysmal cough on swallowing food which were caused by fish bone. The diagnosis of tracheoesophageal fistula was made by the esophagogram, chest CT, and esop aecopy. By using the therapeutic endoscopy with an injection of the fibrinogen-glue, the tracheoesopeal fistula was obliterated completely with dramatic symptomatic improvement. Here we conqluded that this method would be the one of the best methods for the treatment of tracheoesophageal fistula. (Korean J Gastrointest Endosc 17: 49-54, 1997)

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증례 : 결핵성 기관지 식도루 1예 ( Case Reports : A Case of Tuberculous Bronchoesophageal Fistula ): Korean J Gastrointest Endosc 1995;15(2):235-239. Published online November 30, 1994

Abstract PDF: Tuberculous bronchoesophageal fistula is a rare disease. We experienced a case of the tuberculous bronchoesophageal fistula, which was found by endoscopy and surgically confirmed. A sixty seven years old female patient complained of foreign body sensation in the throat and frequent aspiration, especially after liquid meal. Esophagoscopic ex- aminatian showed the orifice of the fistula in the midesophagus at the level of 28 cm from the incisors. Esophagogram showed bronchoesophageal fistula between midesophagus and the right intermediate bronchus. A bronchoscopy visualized fistulous tract with granulation in the right intermediate bronchus. Biopsy specimens obtained from the bronchus revealed the esophageal tissue with granulation and multinucleated giant cells. Fistulectomy with wrapping procedure was performed successfully. Surgical pathologic findings confirmed a small focal granuloma and chronic inflammations, compatible with tuberculosis. There was no evidence of malignancy at the specimens. She was treated with anti-tuberculous agents and became well.

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증례 : 기관식도누공이 병발한 T-임파구성 임파종 ( Case Reports : Tracheoesophageal Fistula in a Patient with T-cell Lymphoma ): Korean J Gastrointest Endosc 1995;15(2):219-222. Published online November 30, 1994

Abstract PDF: Although lymphoma may involve any part of gastrointestinal tract either primary or secondary, esophageal involvement is rare. Secondary esopahgeal involvement of lymphoma is showing an incidence between 0% and 6% with autopsy series and lesser then 1% in living patients. The occurrence of a tracheoesophageal fistula(TEF) in patient with lymphoma is even more rare. We describe one case of TEF due to secondary esophageal invasion of T-cell lympboma and review the literature, with particular attention to chest CT and esophagoscopic finding, and endoscopic biopsy result.

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