Pleural connection treated with stent plus endobronchial valve.

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Interventional Endoscopy

Background:

• Esophago-pleural fistula (EPF) is a rare, severe condition with high morbidity and mortality.
• Surgical repair is standard but not feasible for all patients.
• Previous endoscopic treatments for chronic EPF have shown limited success.

Purpose of the Study:

• To describe a novel endoscopic and bronchoscopic management strategy for a refractory esophago-pleural fistula in a non-surgical candidate.

Main Methods:

• A patient with refractory EPF after sleeve gastrectomy and Roux-en-Y esophagojejunostomy was treated.
• Initial management involved an endobronchial valve within a biliary metal stent.
• A fully covered biliary stent with a deployed endobronchial valve was used for fistula closure.

Main Results:

• The combined stent and valve technique facilitated gradual decompression of the abscess cavity.
• Imaging at 6 months confirmed complete resolution of the esophago-pleural fistula.
• The stent and valve were successfully removed after fistula closure.

Conclusions:

• Endoscopic and bronchoscopic management is a viable alternative for non-surgical candidates with EPF.
• This novel technique of deploying a valve within a stent is a promising minimally invasive solution for refractory EPF.