Conservative Management of a Rare Gastrobronchial Fistula Following Minimally Invasive Esophagectomy: A Case Report

TL;DR

A rare case of gastrobronchial fistula after esophagectomy was managed conservatively using a stent and endoscopic sutures.

Contribution

Presents a rare case of long-term gastrobronchial fistula managed conservatively with a novel combination of stent and endoscopic suture device.

Findings

A 78-year-old patient with a GBF was successfully managed with a self-expanding stent and X-Tack sutures.

Conservative treatment with jejunostomy feeds and stent placement allowed stable discharge without surgery.

Combination of Endo-Flex stent and X-Tack device provided effective fistula management in a high-risk patient.

Abstract

A gastrobronchial fistula (GBF) is an uncommon condition in which an abnormal connection develops between the stomach and the lungs. It can occasionally arise as a complication following esophagectomy for esophageal adenocarcinoma. Management of GBF includes both surgical and nonsurgical approaches, depending on the patient’s condition and comorbidities. Conservative management focuses on diversion to promote fistula closure; options include esophageal stents, fasting, nasogastric drainage, proton pump inhibitors, and jejunostomy feeds. Surgical options include resection of the fistula, anastomosis revision, and closure of the gastric conduit and bronchial aperture. We present a rare case of a 78-year-old male diagnosed with a GBF nearly two years after a minimally invasive distal esophagectomy for esophageal adenocarcinoma. Multiple diagnostic modalities, including endoscopy, CT, and contrast esophagram, were used to establish the diagnosis. The patient elected stent placement from the esophagus to the distal stomach due to poor functional status and was maintained on jejunostomy tube feeds. He was discharged in stable condition. This case highlights a conservative approach to treating GBF using a self-expanding stent (Endo-Flex GmbH, Voerde, Germany) and X-Tack (Apollo Endosurgery, Inc., Austin, TX, USA), an endoscopic suture device used to anchor the stent.

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