Five Steps to Success - Advanced Interdisciplinary Endoscopic Therapy in a Case of an Intrathoracic Insufficiency of the Esophagogastrostomy and the Development of a Significant Esophagobronchial Fistula

Author(s): Dorte Wichmann, Dietmar Stuker, Karolin Thiel, Helene Haberle, Felicitas Ruckh, Emanuel Zerabruck, Michael Bockeler, Jurgen Hetzel

Introduction: Endoscopic negative pressure therapy (ENPT) is an effective new method to treat patients with anastomotic insufficiencies of the upper gastrointestinal tract. Development of an esophagobronchial fistula in situation of postesophagectomy anastomotic insufficiency is a rare but challenging and potentially life-threatening complication. In cases of contact to the respiratory tract ENPT is non-operatively because of air leakage.

Case Report: We report about a patient with a bronchial fistula going out from an esophago-mediastinal cave caused by an anastomotic insufficiency. Five steps to an optimal endoscopic treatment were needed. Finally a combination of endobronchial stenting and active drainage of the mediastinal cave and the stomach was used.

Discussion: Successful outcome in this case is attributable to good interdisciplinary communication of all attending physicians and the imaginative combined usage of endoscopic devices.