The use of Watanabe spigots in the management of bronchoesophageal fistulas

Česká verzia

Authors: Marek Vojtko ¹ ; Martin Ďuriček ¹ ; Michal Demeter ¹ ; Ivan Kocan ² ; Anton Dzian ³ ; Peter Bánovčin ¹
Published in the journal: Gastroent Hepatol 2024; 78(4): 335-342
Category: Clinical and Experimental Gastroenterology: Review Article
doi: https://doi.org/10.48095/ccgh2024335

Summary

Bronchoesophageal and bronchogastric fistulas are rare complications of thoracic surgery as esophagectomy, malignancy or prolonged endotracheal intubation. Although uncommon, their morbidity and mortality is substantial. Treatment of these fistulas is challenging and often lengthy with limited success rates. Endoscopic treatment may be the treatment of choice for some types of fistulas, but despite a variety of methods available, the success rate is relatively low with little consistent data about its effectiveness. At the same time, new technologies and devices have become available with a potential to address these complicated conditions. One of them are Watanabe spigots, initially used in pneumology for the treatment of persistent pneumothorax and pyothorax with bronchial fistula. In the presented case reports Watanabe spigots are used in combination with over-the-scope clips in two of our patients with bronchoesophageal fistulas fol lowing esophagectomy with promising results. We also present an overview of endoscopic methods of therapy in the context of and separately discuss available evidence about the possibilities of the use of Watanabeho spigots in the treatment of bronchoesophageal fistulas.

Keywords:

bronchoesophageal fistula – Watanabe spigot – esophagectomy – over-the-scope clip

Zdroje

1. Drucker NA, Cox CS. Adult presentation of congenital tracheooesophageal fistula treated as asthma and recurrent respiratory infections. Lancet 2023; 402 (10419): 2326–2327. doi: 10.1016/S0140-6736 (23) 02568-0.

2. Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am 2003; 13 (2): 271–289. doi: 10.1016/s1052-3359 (03) 00030-9.

3. Aggarwal D, Mohapatra PR, Malhotra B. Acquired bronchoesophageal fistula. Lung India 2009; 26 (1): 24–25. doi: 10.4103/0970-2113.45201.

4. Lambertz R, Hölscher AH, Bludau M et al. Man agement of tracheo‐ or bronchoesophageal fistula after Ivor‐Lewis esophagectomy. World J Surg 2016; 40 (7): 1680–1687. doi: 10.1007/s00 268-016-3470-9.

5. Mangi AA, Gaissert HA, Wright CD et al. Benign broncho-esophageal fistula in the adult. Ann Thorac Surg 2002; 73 (3): 911–915. doi: 10.1016/s0003-4975 (01) 03582-2.

6. Muniappan A, Wain JC, Wright CD et al. Surgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg 2013; 95 (4): 1141–1146. doi: 10.1016/j.athoracsur.2012.07.041.

7. Elser T, Frederick A, Penn E et al. Benign tracheal esophageal fistula. Oper Tech Thorac Cardiovasc Surg 2019;  25 (1): 27–41.

8. Debourdeau A, Gonzalez JM, Dutau H et al. Endoscopic treatment of nonmalignant tracheoesophageal and bronchoesophageal fistula: results and prognostic factors for its suc cess. Surg Endosc 2019; 33 (2): 549–556. doi: 10.1007/s00464-018-6330-x.

9. Haito-Chavez Y, Law JK, Kratt T et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 2014; 80 (4): 610–622. doi: 10.1016/j.gie.2014.03.049.

10. Yankovic F, Castillo C, Saenz R et al. Endoscopic argon plasma coagulation in recurrent tracheoesophageal fistula. Clinical series and review of the literature. Gastroenterol Hepatol 2009; 32 (9): 600–604. doi: 10.1016/j.gastrohep.2009.06.012.

11. Cereatti F, Grassia R, Drago A et al. Endoscopic management of gastrointestinal leaks and fistulae: what option do we have? World J Gastroenterol 2020; 26 (29): 4198–4217. doi: 10.3748/wjg.v26.i29.4198.

12. Al Akhfash AA, Al-Mesned A, Al Fayadh M. Amplatzer septal occluder and atrioventricular block: a case report and literature review. J Saudi Heart Assoc 2013; 25 (2): 91–94. doi: 10.1016/j.jsha.2013.01.002.

13. Belle A, Lorut C, Lefebvre A et al. Amplatzer occluders for refractory esophago-respiratory fistulas: a case series. Endosc Int Open 2021; 9 (9): E1350–E1354. doi: 10.1055/a-1490-9001.

14. Kawabata H, Sone D, Yamaguchi K et al. Fil ling of polyglycolic acid sheets for closure of gastrointestinal fistulas with an easily deliver able technique using a guidewire. Gastroenterol Res 2020; 13 (3): 96–100. doi: 10.14740/gr1284.

15. Watanabe Y, Matsuo K, Tamaoki A et al. Bronchial occlusion with endobronchial Watanabe spigot. J Bronchology 2003; 10 (4): 264–267. doi: 10.1097/00128594-200310000-00005.

16. Inage T, Nakajima T, Fujiwara T et al. Bronchial embolization with an endobronchial Watanabe spigot for broncho-gastric tube fistula. Respiration 2017; 94 (4): 375–379. doi: 10.1159/000479165.

17. Fukuda S, Koyama S, Kusumoto H et al. Suc cessful repair of a gastrobronchial fistula after esophagectomy: the sandwich technique with the endobronchial Watanabe spigot and the over-the-scope clip system. Surgery 2021; 169 (6): e17–e18. doi: 10.1016/j.surg.2021.02.019.

18. Yutaka Y, Isowa M, Date H. A novel guide-wire-assisted silicone spigot placement for endobronchial occlusion in a complicated airway tract: application of medical thoracoscopy. J Thorac Dis 2020; 12 (3): 1138–1141. doi: 10.21037/jtd.2019.12.49.

19. Himeji D, Tanaka G, Fukuyama C et al. Clinical evaluation of endoscopic bronchial occlusion with an endobronchial Watanabe spigot for the management of intractable pneumothorax, pyothorax with bronchial fistula, and postoperative air leakage. Intern Med 2020; 59 (15): 1835–1839. doi: 10.2169/internalmedicine.3900-19.

20. Sakugawa M, Nishii K, Fukamatsu N et al. EWS. J Jpn Soc Respir Endosc 2014;  36: 538–541.

21.Yoshida M, Sakiyama S, Toba H. Therapeutic experience with endobronchial Watanabe spigot in our hospital-the potential for long-term placement. J Jpn Soc Resp Endosc 2009;  31: 5–9.

22. Uesato M, Kono T, Akutsu Y et al. Endoscopic occlusion with silicone spigots for the closure of refractory esophago-bronchiole fistula after esophagectomy. World J Gastroenterol 2017; 23 (28): 5253–5256. doi: 10.3748/wjg.v23.i28.5253.

ORCID autorov

M. Vojtko 0000-0002-8374-2741,

M. Ďuriček 0000-0002-0754-4532,

M. Demeter 0000-0003-4585-9380,

I. Kocan 0000-0001-8965-3996,

A. Dzian 0000-0002-4883-3605,

P. Bánovčin 0000-0001-6694-9364.

Doručené/Submitted: 7. 7. 2024

Prijaté/Accepted: 22. 7. 2024

Korešpondenčný autor

MUDr. Martin Ďuriček, PhD.

Interná klinika – gastroenterologická