Endoscopic treatment for intractable esophageal-mediastinal fistula after repair in a patient with Boerhaave syndrome

Abstract

A 66-year-old man experienced epigastric pain after massive vomiting. He was diagnosed with spontaneous perforation of the esophagus. Laparoscopic transhiatal repair was immediately performed. After surgery, esophageal-mediastinal fistula resulting from the anastomotic insufficiency remained and didn’t improve with conservative treatment. We attempted to close the fistula with a polyglycolic acid sheet and fibrin glue via endoscopy. First, a polyglycolic acid sheet was packed in the fistula. Then, we sprayed fibrin glue on the sheet. Finally, we used endoscopic clips to prevent from falling off the sheet. As a result, leakage stopped completely and the endoscopy confirmed closure of the fistula. We report endoscopic closure of the remaining esophageal fistula after surgical repair with literature reviews.