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. 2020 May;8(5):E591-E595.
doi: 10.1055/a-1119-6352. Epub 2020 Apr 17.

Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study

Yasuaki Nagami  1 , Masaki Ominami  1 , Taishi Sakai  1   2 , Shusei Fukunaga  1 , Fumio Tanaka  1 , Koichi Taira  1 , Tetsuya Tanigawa  1 , Shigeru Lee  3 , Toshio Watanabe  1 , Yasuhiro Fujiwara  1
Affiliations

Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study

Yasuaki Nagami et al. Endosc Int Open. 2020 May.

Abstract

Background and study aims Esophageal fistulas after esophagectomy are associated with high mortality and poor quality of life. They are sometimes intractable to conservative management and surgery that increases mortality. Few studies have assessed use of polyglycolic acid (PGA) sheets with fibrin glue for esophageal fistulas. We investigated the safety of using PGA sheets with fibrin glue for esophageal fistulas after esophagectomy. Patients and methods This was a single-center prospective pilot study. Patients who had refractory esophageal fistulas after esophagectomy were included. PGA sheets were filled in the fistula using biopsy forceps. Fibrin glue was applied to the PGA sheets. We repeated the procedure 1 week later. The outcome measures were the incidence of adverse events (AEs) and closure of the fistula. Results Five patients were assessed. No adverse events were observed. The esophageal fistula was closed with the application of PGA sheets four times in 40 % (2/5) of the cases. Conclusions PGA sheets with fibrin glue were safe for esophageal fistula closure after esophagectomy and do not involve the risk of AEs.

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Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Polyglycolic acid (PGA) sheets with fibrin glue application. a, b Ablation of the mucosa around the fistula using argon plasma coagulation (APC). c PGA sheets (yellow arrow) used to fill the fistula using biopsy forceps through the scope channel or over the scope. d Application of fibrinogen and thrombin solutions of fibrin glue to the PGA sheets.
Fig. 2
Fig. 2
Successful case of closure of esophageal fistula. a Endoscopic view showing the esophageal fistula located anastomosis after esophagectomy). b Application of polyglycolic acid (PGA) sheets with fibrin glue along with endoclips. c Esophageal fistula was observed 1 week later. d The same procedure was repeated four times. e Fistula covered with granulation tissue. f Endoscopic view showing complete closure of the esophageal fistula.
See this image and copyright information in PMC

Comment in

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