Endoscopic management of gastro‐bronchial fistula following two‐stage esophagectomy using over‐the‐scope‐clip (OTSC): Case series

Post‐esophagectomy gastro‐bronchial fistula (GBF) has significant morbidity and mortality. Management of GBF remains non standardized due to its rarity and limited available evidence. Reoperation and surgical repair have been the main approach. More recently, multimodal endoscopic treatment is gaining popularity as primary treatment option due to its relatively non invasiveness, increasing evidence of success rate, and reduced morbidity. We present a case series of post‐esophagectomy GBF managed endoscopically using over‐the‐scope‐clip (OTSC). A dedicated, prospective, and contemporaneous regional upper gastrointestinal cancer database was searched to identify post‐esophagectomy GBF from January 2015 to December 2017. Clinical notes and investigation images of identified cases were analyzed. Three patients developed post‐esophagectomy GBF during the study period. The mean age of patients was 53. The mean time of GBF diagnosis was 233 days (range: 20‐608). Two patients had endoscopic stent placement prior to OTSC application. Primary technical success was achieved in all patients. No adverse events were reported. Two patients had complete healing of GBF and the mean healing time was 15 days (range: 6‐24). One patient who had significant co‐morbidities (peripheral arterial disease, diabetes, hepatitis C, rheumatoid arthritis, and heavy smoker) developed a persistent leak of GBF and died from a cardiac event. GBF and its surgical treatment are associated with high morbidity and mortality. We present this case series where two out of three patients with GBF were successfully treated with this modality. Endoscopic therapy incorporating OTSC placement is a feasible option in the management of post‐esophagectomy GBF. Further studies are required to understand and establish its role in the treatment algorithm of post‐esophagectomy GBF.