English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

A 69-year-old man underwent an upper gastrointestinal endoscopy, which revealed a large submucosal lesion in the distal esophagus with normal overlying mucosa. Endoscopic ultrasound (EUS) showed a hypoechoic lesion measuring 80×40×30mm in the submucosa (●" Fig.1). A subtotal esophagectomy was performed. Histopathological examination of the resected tissue revealed a duplication cyst. The patient developed sepsis 3 weeks after surgery. A computed tomography (CT) scan revealed evidence of dehiscence of the esophagogastric anastomosis with a large mediastinal collection (●" Fig.2). Upper gastrointestinal endoscopy confirmed the presence of a dehiscence affecting an 8-mm section of the esophagogastric anastomosis (●" Fig.3a). Pus was aspirated through the fistula orifice and two double-pigtail plastic stents were placed endoscopically to drain the abscess (●" Fig.3b). There was rapid improvement in the patient’s clinical condition. After 1 week, the stents were removed and an over-the-scope clip (OTSC) was applied to close the fistula. Unfortunately, despite this, a Gastrografin swallow revealed persistence of the fistula. A third upper gastrointestinal endoscopy was performed and after removing the OTSC, we applied argon plasma coagulation (APC) and three through-the-scope clips, which effectively sealed the fistula (●" Fig.3c). Resolution of the mediastinal abscess as well as the fistula was confirmed on a further thoracic CT scan and Gastrografin swallow (●" Fig.4). This case highlights the potentially useful role of endoscopic drainage and clipping devices in the management of a rare but serious adverse event of esophageal surgery.

Sequential endoscopic drainage and clip closure of an intrathoracic esophagogastric anastomotic dehiscence