Clin Endosc.  2015 Sep;48(5):440-443. 10.5946/ce.2015.48.5.440.

Treatment of Traumatic Esophagopleural Fistula Using the Over-the-Scope-Clip System

• Kim JH
• Park JJ
• Jung IW
• Kim SH
• Kim HD
• Choe JW
• Joo MK
• Kim HG

• KMID: 2148558
• DOI: http://doi.org/10.5946/ce.2015.48.5.440

Abstract

Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.

Keyword

Esophagopleural fistula; Over-the-scope-clip; Negative-pressure wound therapy

MeSH Terms

Accidents, Traffic
Adult
Esophagus
Fistula*
Humans
Negative-Pressure Wound Therapy
Rupture

Figure

• 

  Fig. 1 Computed tomography examination shows the presence of pleuroparenchymal injury (pneumothorax, pleural effusion [black arrows], and subcutaneous emphysema [white arrowhead]), suggestive of esophageal rupture.

• 

  Fig. 2 Diagnosis of an esophagopleural fistula (EPF). (A) An upper gastrointestinal series with Gastrografin (Bayer) shows a fistula tract connecting the left pleural space and the closure site of the distal esophagus (black arrow). (B) Esophagogastroduodenoscopic examination reveals an esophageal orifice of the EPF at the distal esophagus (white arrowhead).

• 

  Fig. 3 Endoscopic findings during the procedure. (A) The traumatic-type over-the-scope-clip (OTSC) system is deployed at the end of the transparent application cap and approaches the esophageal orifice. (B) The OTSC system is successfully applied to the target lesion.

• 

  Fig. 4 Follow-up evaluation after the procedure. (A) An upper gastrointestinal series with Gastrografin (Bayer), performed 5 days after placement of the over-the scope clip system reveals no contrast leakage at the distal esophagus. (B) An esophagogastroduodenoscopic examination, performed 2 weeks postoperatively, shows that the esophageal orifice of the esophagopleural fistula at the distal esophagus has completely healed.

Reference

1. Khamaysi I, Suissa A, Yassin K, Gralnek IM. Closure of a persistent esophagopleural fistula using an over-the-scope clipping device. Endoscopy. 2013; 45(Suppl 2 UCTN):E29–E30. PMID: 23526502.

2. Orgill DP, Manders EK, Sumpio BE, et al. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009; 146:40–51. PMID: 19541009.

3. Lambert KV, Hayes P, McCarthy M. Vacuum assisted closure: a review of development and current applications. Eur J Vasc Endovasc Surg. 2005; 29:219–226. PMID: 15694791.

4. Cro C, George KJ, Donnelly J, Irwin ST, Gardiner KR. Vacuum assisted closure system in the management of enterocutaneous fistulae. Postgrad Med J. 2002; 78:364–365. PMID: 12151694.

5. Sandmann M, Heike M, Faehndrich M. Application of the OTSC system for the closure of fistulas, anastomosal leakages and perforations within the gastrointestinal tract. Z Gastroenterol. 2011; 49:981–985. PMID: 21811949.

6. Nishiyama N, Mori H, Kobara H, et al. Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol. 2013; 19:2752–2760. PMID: 23687412.

7. Mennigen R, Colombo-Benkmann M, Senninger N, Laukoetter M. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC). J Gastrointest Surg. 2013; 17:1058–1065. PMID: 23400507.

8. Singhal S, Changela K, Papafragkakis H, Anand S, Krishnaiah M, Duddempudi S. Over the scope clip: technique and expanding clinical applications. J Clin Gastroenterol. 2013; 47:749–756. PMID: 23751852.

9. Dişibeyaz S, Köksal AS, Parlak E, Torun S, Şaşmaz N. Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature. Clin Res Hepatol Gastroenterol. 2012; 36:614–621. PMID: 22704818.

10. Hagel AF, Naegel A, Lindner AS, et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg. 2012; 16:2132–2138. PMID: 22903364.

11. Weiland T, Fehlker M, Gottwald T, Schurr MO. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc. 2013; 27:2258–2274. PMID: 23340813.

12. Kirschniak A, Kratt T, Stüker D, Braun A, Schurr MO, Königsrainer A. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007; 66:162–167. PMID: 17591492.

13. Schurr MO, Arezzo A, Ho CN, Anhoeck G, Buess G, Di Lorenzo N. The OTSC clip for endoscopic organ closure in NOTES: device and technique. Minim Invasive Ther Allied Technol. 2008; 17:262–266. PMID: 18686172.

14. Aly A, Lim HK. The use of over the scope clip (OTSC) device for sleeve gastrectomy leak. J Gastrointest Surg. 2013; 17:606–608. PMID: 23090281.

15. Iacopini F, Di Lorenzo N, Altorio F, Schurr MO, Scozzarro A. Over-the-scope clip closure of two chronic fistulas after gastric band penetration. World J Gastroenterol. 2010; 16:1665–1669. PMID: 20355247.