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Most serious button-battery ingestions are not witnessed and they can cause life threatening complications. We present here the case of a 3-year-old girl who swallowed a button battery in January 2016 with a delayed diagnosis being made after 10 days. A 5-mm tracheoesophageal fistula was endoscopically diagnosed (▶Fig. 1). The first attempts at closure involved the deployment of two successive esophageal covered stents between January and May (▶Fig. 2). The fistula decreased in size but persisted, so we then attempted controlled wound healing with a nasogastric tube, but the fistula still remained. Next, we tried a side fistula abrasion with argon plasma coagulation. Unfortunately, these techniques did not allow full recovery, even though the fistula reduced notably. After 1 year, we tried endoscopic submucosal dissection (ESD) of the mucosa surrounding the fistula, resecting a 1-cm mucosal patch centered on the fistula. After injecting the submucosa and making the mucosal incision, we used a DualKnife (Olympus) to dissect the fibrotic area. After the dissection, the fistula was closed with three clips anchored into the submucosa of the resected area (▶Fig. 3; ▶Video1). We arranged a radiologic check with contrast, which Video 1 Views of the fistula and previous attempts to close it. The endoscopic submucosal dissection procedure is performed to resect the surrounding mucosa, which is subsequently clipped to close the fistula. ▶ Fig. 1 Appearance of the tracheoesophageal fistula in a 3-year-old girl after ingestion of a button battery.

endoscopy

Successful endoscopic closure of a refractory button-battery tracheoesophageal fistula in a 3-year child using endoscopic submucosal dissection of the surrounding mucosa