Recurrent tracheoesophageal fistula is a common postoperative complication of esophageal atresia 1 . The surgical treatments utilize muscle and pleural flaps 2 . Furthermore, endoscopic fistula closure with fibrin glue, a biomaterial, can be achieved by epithelializing, promoting circulation, and inhibiting leukocyte infiltration 1 . In adults, endoscopic fistula closure using a polyglycolic acid (PGA) sheet is useful for treating postoperative esophageal anastomotic fistulas 3 . However, no such pediatric reports are available.
Herein, we report the first pediatric case of endoscopic fistula closure with PGA sheet ( Video 1 ).
Video 1 Use of polyglycolic acid sheets and fibrin glue as an effective alternative to standard procedures during pediatric endoscopic fistula closure.
A 3-year-old girl was admitted with the chief complaint of persistent fever and cough after eating. She underwent postnatal thoracoscopic radical esophagectomy for type C esophageal atresia. Owing to postoperative complication, she underwent multiple endoscopic balloon dilations.
Esophagogastroduodenoscopy revealed an esophageal fistula on the oral posterior wall of the esophageal anastomosis ( Fig. 1 ). Tracheal esophagography ( Fig. 2 ) revealed tracheoesophageal fistula.
Fig. 1.
A fistula on the posterior wall of the oral side of the esophageal anastomosis.
Fig. 2.
Esophagography revealed the trachea (yellow arrow).
First, mucosa around the fistula was cauterized using hot biopsy through a single-channel upper gastrointestinal endoscope ( Fig. 3 ). Subsequently, small pieces of PGA sheet (Neoveil; Gunze Co., Osaka, Japan) were grasped with biopsy forceps, immersed in fibrinogen solution, and used to fill the fistula through the scope ( Video 1 ). Finally, fibrinogen and thrombin solutions of fibrin glue (Beriplast P Combi-Set; CSL Behring Pharma, Tokyo, Japan) were applied to the PGA sheets ( Fig. 4 ).
Fig. 3.
Image after cauterization of the area around the fistula with hot biopsy forceps, soft mode 80 W of electrosurgical generator (VIO300D; ERBE Elektromedizin GmbH, Tübingen, Germany).
Fig. 4.
Fibrinogen and thrombin solutions of fibrin glue were applied to the polyglycolic acid sheets.
Endoscopy 3 weeks later confirmed fistula closure ( Fig. 5 ), and oral intake by the patient was possible without symptoms.
Fig. 5.
Endoscopy after 3 weeks revealed closure of the fistula.
Fibrin glue is generally used in the treatment of pediatric tracheoesophageal fistula. PGA sheets acting as tissue-regenerative scaffolds may effectively help in the healing process, as granulation tissue can fill and cover the fistula 3 .
Endoscopy_UCTN_Code_TTT_1AO_2AI
Footnotes
Competing interests The authors declare that they have no conflict of interest.
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References
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