Endoscopic treatment with lumen-apposing metal stent in a patient with esophageal stricture and esophagobronchial fistula: a case report

TL;DR

A lumen-apposing metal stent was successfully used to treat a complex post-surgery esophageal condition involving a stricture and fistula.

Contribution

This is the first reported case of using LAMS for malignant esophageal stricture and postoperative fistula.

Findings

LAMS effectively relieved the obstruction and sealed the esophagobronchial fistula.

The patient experienced sustained symptom resolution for 4 weeks after the procedure.

LAMS placement is a technically feasible and minimally invasive treatment option.

Abstract

Endoscopic interventions for postoperative esophageal strictures and fistulas are inherently challenging. The use of conventional self-expandable metallic stents has been restricted due to high migration rates. There has been no report about malignant esophageal stricture and postoperative fistula managed with a lumen-apposing metal stent (LAMS). We present a case of refractory postoperative anastomotic stricture and esophagobronchial fistula following esophagectomy. Endoscopic deployment of a LAMS effectively relieved the obstruction and sealed the fistula, with the patient tolerating the procedure well and experiencing sustained symptom resolution for 4 weeks. This case suggests the potential role of LAMS in maintaining luminal patency and sealing fistulas. Endoscopic ultrasound-guided LAMS placement should be a technically feasible, effective and minimally invasive approach for postoperative esophageal stenosis and fistula.

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