title: Successful treatment of intractable esophagothoracic fistula using covered self-expandable stent.
abstract: This report concerns the successful treatment with a covered self-expandable stent of an intractable thoracoesophageal fistula after total esophagectomy for esophageal cancer. Total esophagectomy was performed on a 68-year-old man who presented with a huge esophageal cancer in the lower esophagus. Massive leakage was observed on the 5th day postoperatively. Since high fever and coughing continued, he was diagnosed as having esophagothoracic fistula and pyothorax, after which fenestration of the right chest wall was performed. Although the patient's general condition was getting better, stenosis near the anastomosis (esophagogastrostomy) and the esophagothoracic fistula were resistant to treatment with balloon dilatation and repeated endoscopic mucotomy. Further treatment, consisting of glue or fibrin sealant injection was not effective. After a covered self-expandable stent had been placed endoscopically, however, the fistel was completely cured in 2 months. This new endoscopic approach thus represents a promising option for the treatment of intractable esophagothoracic fistula.
authors.affiliation: Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. sakakura@koto.kpu-m.ac.jp
authors.forename: Chouhei
authors.initials: C
authors.lastname: Sakakura
authors.forename: Akeo
authors.initials: A
authors.lastname: Hagiwara
authors.forename: Dai
authors.initials: D
authors.lastname: Kato
authors.forename: Katsuya
authors.initials: K
authors.lastname: Deguchi
authors.forename: Takuya
authors.initials: T
authors.lastname: Hamada
authors.forename: Yoshizumi
authors.initials: Y
authors.lastname: Itoi
authors.forename: Shoji
authors.initials: S
authors.lastname: Mitsufuji
authors.forename: Kei
authors.initials: K
authors.lastname: Kashima
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Yamagishi
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000601:surgery*; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D004945:Esophagoscopy; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D011859:Radiography; D015607:Stents