Endoscopic closure of acquired oesophagorespiratory fistulas with cardiac septal defect occluders or vascular plugs

Jing Li1e， Xinglin Gao2e， Jingjing Chen3e， Miaochan Lao4e， Shushui Wang5e， Guohong Zenge

Objectives

To report an endoscopic treatment for inoperable oesophagorespiratory fistulas (ORFs).

Patients and methods

Six patients with inoperable acquired tracheobronchial-oesophageal fistulas (four males and two females; mean age, 70.2 ± 10.28 years) were included. Cardiac septal defect occluders or vascular plugs were implanted through a flexible bronchoscope to close the ORFs. Monthly follow-ups were done for 16 months.

Results

All fistulas were successfully closed immediately after the procedure. The severe aspirated pneumonia was controlled in 7–10 days. The two mechanically ventilated patients were weaned successfully from the ventilator, and the general condition of patients improved rapidly. However, the fistulas recanalised in four patients because of the cutting effect of the edge of the occluders 1–12 months after the procedure. Other reasons, such as compression of the tracheal intubation balloon and repeated inflammation of the oesophageal diverticulum, may also have contributed to the recanalisation.

Conclusions

Endoscopic closure of acquired ORFs with cardiac septal defect occluders or vascular plugs improve patients' general condition immediately after the procedure, but may result in recanalisation longterm. The occlusion might be considered an abridgement to surgery.

respiratory medicine

August 2015Volume 109, Issue 8, Pages 1069–1078

DOI: http://dx.doi.org/10.1016/j.rmed.2015.04.014 |