Year 2020 / Volume 112 / Number 9
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Refractory tracheoesophageal fistula management with Amplatzer Occluder® placement

733-734

DOI: 10.17235/reed.2020.6719/2019

João Carlos Silva, Pedro Braga, Daniel Coutinho, Carlos Fernades,

Abstract
Tracheoesophageal fistulas (TEF) in adults can be managed either surgically or endoscopically, depending on their etiology, size, anatomy and patient comorbidities. A 68-year-old female was admitted to the ER due to dysphagia and a cough. The patient had a medical history of TEF resulting from a tracheostomy and prolonged mechanical ventilation. Previous endoscopic treatment had failed, namely 3-attempts of closure with an over-the-scope clip (OTSC®). The patient refused surgery. After a multidisciplinary discussion (Gastroenterology, Pneumology, Surgery and Interventional-Cardiology), we decided to attempt Amplatzer-Occluder® placement. An 8mm Amplatzer-Occluder® was placed from the tracheal side, with sequential opening of the esophageal and tracheal strands (under endoscopic, bronchofibroscopic and fluoroscopic visualization). Nevertheless, migration of the device occurred 8-weeks later. Percutaneous endoscopic gastrostomy (PEG) was placed and the patient was referred to surgery. When there is extensive fibrosis that is not amendable to the application of clips, atrial septal defect occluder devices can be considered to manage TEF. Nevertheless, there is a need to develop strategies to minimize migration risk.
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19/04/2021 22:18:18
Soy médico gastroenterologo y tengo un caso con iguales características


02/12/2020 5:03:37
That is a great job !


References
Rabenstein, T., Boosfeld, C., Henrich, R., et al., First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy. Chest, 2006. 130(3): p. 906-9.
Subtil, J.C., Valenti, V., Cienfuegos, J. A., et al., Successful endoscopic closure of multiple tracheoesophageal fistulas following implantation of two atrial septal defect occluders. Endoscopy, 2016. 48(S 01): p. E346-E347.
Repici, A., Presbitero, P., Carlino, A., et al., First human case of esophagus-tracheal fistula closure by using a cardiac septal occluder (with video). Gastrointest Endosc, 2010. 71(4): p. 867-9.
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Silva J, Braga P, Coutinho D, Fernades C. Refractory tracheoesophageal fistula management with Amplatzer Occluder® placement. 6719/2019


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Publication history

Received: 31/10/2019

Accepted: 02/12/2019

Online First: 02/09/2020

Published: 10/09/2020

Article revision time: 31 days

Article Online First time: 307 days

Article editing time: 315 days


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