Postlobectomy bronchoesophageal fistula treated with endoscopic helical tacking system and anchor-pronged clip

Postsurgical bronchoesophageal fistulas represent challenging adverse events (AEs). We report a case of a postsurgical bronchoesophageal fistula endoscopically treated.

A 50-year-old woman underwent a robot-assisted right upper lobectomy and lymphadenectomy for moderately differentiated acinar lung adenocarcinoma (staging: pT1a; pN0). Six weeks later, a CT imaging raised suspicion of a bronchoesophageal fistula, which was confirmed by a contrast-enhanced x-ray examination, upper endoscopy (7-mm fistula), and bronchoscopy. After multidisciplinary discussion, endoscopic closure of the fistula was attempted using a helical tacking system deployed in a Z-shape to approximate the fibrotic fistula edges and an anchor-pronged clip to enhance tissue grasping to achieve definitive closure of the fistula.

The procedure was well tolerated, and 4 weeks later, both upper endoscopy and x-ray esophageal transit demonstrated fistula closure. At 10-month follow-up, the patient was asymptomatic, and the fistula was persistently closed.

Combined endoscopic management with a helical tacking system and anchor-pronged clip successfully resolved this AE, highlighting a minimally invasive therapeutic option for such challenging cases.