Amplatzer occluders for refractory esophago-respiratory fistulas: a case series

 

 Permissions and Reprints

Abstract

Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication.

Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake.

Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6).

Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.

Publication History

Received: 12 January 2021

Accepted: 29 March 2021

Article published online:
16 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Debourdeau A, Gonzalez J-M, Dutau H. et al. Endoscopic treatment of nonmalignant tracheoesophageal and bronchoesophageal fistula: results and prognostic factors for its success. Surg Endosc 2019; 33: 549-556
  CrossrefPubMedGoogle Scholar
• 2 Muniappan A, Wain JC, Wright CD. et al. Surgical Treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg 2013; 95: 1141-1146
  CrossrefPubMedGoogle Scholar
• 3 Shen KR, Allen MS, Cassivi SD. et al. Surgical Management of Acquired Nonmalignant Tracheoesophageal and Bronchoesophageal Fistulae. Ann Thorac Surg 2010; 90: 914-919
  CrossrefPubMedGoogle Scholar
• 4 Chauhan SS, Long JD. Management of tracheoesophageal fistulas in adults. Curr Treat Options Gastroenterol 2004; 7: 31-40
  CrossrefPubMedGoogle Scholar
• 5 Repici A, Presbitero P, Carlino A. et al. First human case of esophagus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc 2010; 71: 867-869
  CrossrefPubMedGoogle Scholar
• 6 Traina M, Amata M, De Monte L. et al. Chronic tracheoesophageal fistula successfully treated using Amplatzer septal occluder. Endoscopy 2018; 50: 1236-1237
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Spaander M, Baron T, Siersema P. et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 939-948
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Bertrand G, Jacques J, Rivory J. et al. Deep endoscopic submucosal dissection of a refractory tracheoesophageal fistula using clip-and-line traction: a successful closure. Endoscopy 2017; 49: 1278-1278
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Herth FJF, Peter S, Baty F. et al. Combined airway and oesophageal stenting in malignant airway-oesophageal fistulas: a prospective study. Eur Respir J 2010; 36: 1370-1374
  CrossrefPubMedGoogle Scholar
• 10 Coppola F, Boccuzzi G, Rossi G. et al. Cardiac septal umbrella for closure of a tracheoesophageal fistula. Endoscopy 2010; 42: E318-E319
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Lee H, Jung E, Park M. et al. Closure of a gastrotracheal fistula using a cardiac septal occluder device. Endoscopy 2011; 43: E53-E54
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Ersoz H, Nazli C. A new method of tracheoesophageal fistula treatment: Using an atrial septal defect occluder device for closure – The first Turkish experience. Gen Thorac Cardiovasc Surg 2018; 66: 679-683
  CrossrefPubMedGoogle Scholar
• 13 Miller PE, Arias S, Lee H. et al. Complications associated with the use of the amplatzer device for the management of tracheoesophageal fistula. Ann Am Thorac Soc 2014; 11: 1507-9
  CrossrefPubMedGoogle Scholar
• 14 Rabenstein T, Boosfeld C, Henrich R. et al. First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy. Chest 2006; 130: 906-909
  CrossrefPubMedGoogle Scholar
• 15 Green DA, Moskowitz WB, Shepherd RW. Closure of a broncho-to-neoesophageal fistula using an Amplatzer septal occluder device. Ann Thorac Surg 2010; 89: 2010-2012
  CrossrefPubMedGoogle Scholar
• 16 Cohen-Atsmoni S, Tamir A, Avni Y. et al. Endoscopic occlusion of tracheoesophageal fistula in ventilated patients using an Amplatzer septal occluder. Indian J Otolaryngol Head Neck Surg Off Publ Assoc Otolaryngol India 2015; 67: 196-199
  CrossrefPubMedGoogle Scholar
• 17 Jiang P, Liu J, Yu D. et al. Closure of nonmalignant tracheoesophageal fistula using an atrial septal defect occluder: case report and review of the literature. Cardiovasc Intervent Radiol 2015; 38: 1635-1639
  CrossrefPubMedGoogle Scholar
• 18 Knepp MD, Rocchini AP, Lloyd TR. et al. Long-term follow up of secundum atrial septal defect closure with the amplatzer septal occluder. Congenit Heart Dis 2010; 5: 32-37
  CrossrefPubMedGoogle Scholar
• 19 Buitrago DH, Pinto D, Berkowitz SJ. et al. Fatal hemoptysis after closure of gastrobronchial fistula using an Amplatzer vascular device. Ann Thorac Surg 2018; 105: e71-e73
  CrossrefPubMedGoogle Scholar
• 20 Sang H, Peng L, Zhang G. Tracheoesophageal fistula closed by a new gastrointestinal occluder device. Endoscopy 2020; 1234-6702
  PubMedGoogle Scholar