VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Vicryl patch and fibrin glue as treatment of an esophageal leak
Figure 1. Endoscopic view in the distal esophagus. The fistula open occupies nearly the entire view with a blue intraperitoneal drainage catheter seen in the distance at 3 o’clock. The esophageal lumen is barely seen at 7 o’clock.
A 22-year-old man was referred with a history of achalasia. Prior treatments included 4 pneumatic dilatations, 2 botox injections, PEG-J feeding tube placement, and 2 previous Heller myotomies with a partial fundoplication complicated by dehiscence requiring laparoscopic and percutaneous drainage of an esophageal leak. Conventional upper GI endoscopy revealed a large fistula at the lower esophageal sphincter with a 2-cm fibrotic orifice and a visible tip of the percutaneous drainage tube. A vicryl (Ethicon, Inc.) patch was inserted endoscopically followed by injection of 4 mL Tisseel/fibrin (Tissucol Duo, Baxter, Germany) glue. The esophageal contents were diverted with the use of a partially covered stent (Ultraflex, Boston Scientific, Marlboro, Mass) under fluoroscopic and endoscopic guidance. Three hemostatic clips were placed to anchor the stent. No adverse events were recognized (Fig. 1; Video 1, available online at www.giejournal. org). The patient was advised to maintain a soft mechanical diet and to take nothing by mouth during continued PEG-J feeding, but he was noncompliant with these instructions. Follow-up examinations after 1 month revealed no visible opening. During the endoscopy, 20 mL Hypaque contrast medium (Amersham Health
www.giejournal.org
Inc., Princeton, NJ) was injected into the lumen above the prior fistula under fluoroscopy. No leak of contrast medium was seen. A spontaneously migrated metal stent was found in the stomach, and removal was accomplished with rat-toothed forceps. DISCLOSURE Michael Wallace receives research funding from Cook, Boston Scientific, and Olympus. All other authors declare no financial relationships relevant to this publication. Maria Sylvia Ierardi Ribeiro, MD, Renata A.F.P. de Barros, MD, Irmandade de Santa Casa de Misericordia de Sao Paolo, San Paolo, Brazil, Michael B. Wallace, MD, MPH, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
http://dx.doi.org/10.1016/j.gie.2015.03.1910
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
Vicryl patch and fibrin glue as treatment of an esophageal leak
Figure 1. Endoscopic view in the distal esophagus. The fistula open occupies nearly the entire view with a blue intraperitoneal drainage catheter seen in the distance at 3 o’clock. The esophageal lumen is barely seen at 7 o’clock.
A 22-year-old man was referred with a history of achalasia. Prior treatments included 4 pneumatic dilatations, 2 botox injections, PEG-J feeding tube placement, and 2 previous Heller myotomies with a partial fundoplication complicated by dehiscence requiring laparoscopic and percutaneous drainage of an esophageal leak. Conventional upper GI endoscopy revealed a large fistula at the lower esophageal sphincter with a 2-cm fibrotic orifice and a visible tip of the percutaneous drainage tube. A vicryl (Ethicon, Inc.) patch was inserted endoscopically followed by injection of 4 mL Tisseel/fibrin (Tissucol Duo, Baxter, Germany) glue. The esophageal contents were diverted with the use of a partially covered stent (Ultraflex, Boston Scientific, Marlboro, Mass) under fluoroscopic and endoscopic guidance. Three hemostatic clips were placed to anchor the stent. No adverse events were recognized (Fig. 1; Video 1, available online at www.giejournal. org). The patient was advised to maintain a soft mechanical diet and to take nothing by mouth during continued PEG-J feeding, but he was noncompliant with these instructions. Follow-up examinations after 1 month revealed no visible opening. During the endoscopy, 20 mL Hypaque contrast medium (Amersham Health
www.giejournal.org
Inc., Princeton, NJ) was injected into the lumen above the prior fistula under fluoroscopy. No leak of contrast medium was seen. A spontaneously migrated metal stent was found in the stomach, and removal was accomplished with rat-toothed forceps. DISCLOSURE Michael Wallace receives research funding from Cook, Boston Scientific, and Olympus. All other authors declare no financial relationships relevant to this publication. Maria Sylvia Ierardi Ribeiro, MD, Renata A.F.P. de Barros, MD, Irmandade de Santa Casa de Misericordia de Sao Paolo, San Paolo, Brazil, Michael B. Wallace, MD, MPH, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
http://dx.doi.org/10.1016/j.gie.2015.03.1910
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
