• Jun Sonomura, Tetsunosuke Shimizu, Kohei Taniguchi, Sang-Woong Lee, Ryo Tanaka, Yoshiro Imai, Kotaro Honda, Masaru Kawai, Keitaro Tashiro, and Kazuhisa Uchiyama.
• Department of General and Gastroenterological Surgery.
• Medicine (Baltimore). 2021 Jan 29; 100 (4): e24494e24494.

RationaleAn esophago-bronchial fistula is one of the rare postoperative complications of esophageal cancer. There are various medical treatments, including suturing, endoscopic clip, and fibrin glue. However, these treatments often lead to unsatisfactory results, causing physicians to opt for surgical alternatives. The Over-The-Scope-Clipping (OTSC) system offers an alternative method for fistula closure. It can capture a large amount of tissue and is able to compress the lesion until it has fully healed. However, data indicating the efficacy of OTSC for esophago-bronchial fistula are limited.Patient ConcernsA 64-year-old man presented with an esophago-bronchial fistula after surgery for esophageal cancer. We chose to use a stent as the first line of treatment, but the fistula did not close.DiagnosesIntractable esophago-bronchial fistula associated with esophageal surgery.Interventions And OutcomesOn the 94th postoperative day, fistula closure with OTSC was performed, and no leakage of the contrast agent was observed during fluoroscopy. We also attempted to close the fistula by combining OTSC and argon plasma coagulation (APC) to burn off the scar tissue from around the fistula. The fistula gradually shrank after a total of 4 rounds of OTSC, and closure of the fistula was achieved on the 185th postoperative day. There were no adverse events during the treatment of this case.LessonsWe demonstrate that OTSC is useful in the management of esophago-bronchial fistulas, and may become a standard procedure for the endoscopic treatment of esophago-bronchial fistulas, replacing the use of stents, clips, or glue.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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