Successful Treatment of Refractory Enterocutaneous Fistula After Esophagectomy Using Soft Coagulation by an...

Anastomotic leakage (AL) is a serious complication after esophagectomy, and the refractory fistula (RF) following AL is therapeutically challenging with no optimal management strategies known. Thus, new therapeutic options are required for treating RF.

A 67-year-old man who underwent endoscopic mucosal dissection was subjected to subtotal esophagectomy and reconstruction with a gastric tube through the retrosternal route with cervical anastomosis as additional therapy. On postoperative day 5, leakage from the esophagogastric anastomosis was detected. A refractory enterocutaneous fistula (4 cm in length) developed between the esophagogastric anastomosis (the fistula opening was 1 cm approximately) and cervical skin. The RF did not heal despite the drainage of saliva, enteral nutrition, oral administration of biperiden hydrochloride for orofacial dyskinesia to rest the esophagogastric anastomosis, coagulation factor XIII transvenously, and fibrin glue injection from the opening of the fistula, probably due to difficulty in maintaining the rest of the esophagogastric anastomosis caused by orofacial dyskinesia. On postoperative day 76, soft coagulation to the fistula opening at the esophagogastric anastomosis by an endoscopic approach and to the fistula via the fistula opening at the cervical site by a percutaneous approach was performed. The post-treatment course was uneventful. The RF completely closed immediately after soft coagulation.

Soft coagulation using endoscopic and percutaneous approaches to RF is a minimally invasive procedure and may be a useful option if the fistula opening of the anastomotic site is small and accessible endoscopically, and there are no vital organs around the fistula.