Endoscopic pedicle flap grafting in the treatment of esophageal fistulas: A case report.

BACKGROUND Fistulization is a rare complication of esophageal diverticula. Patients with this condition often require surgery, which unfortunately can be invasive and traumatic. Endoscopic therapy is an alternative method for treating esophageal fistula. Hereby we introduce a new endoscopic technique that uses an esophageal pedicle flap to close esophageal fistulas. CASE SUMMARY A 49-year-old male patient, complaining of backache and choking, was formerly diagnosed with chronic bronchopneumonia. Chest computed tomography and esophagram confirmed the presence of esophageal diverticulum and mediastinal esophageal fistula. The patient was then treated by covering the fistulas using a pedicled flap that was acquired through endoscopic submucosal dissection of a patch from the proximal esophageal mucosa. Then the pedicle flap was reversed 180° to cover the fistula. Titanium clips were used to fix the flap. The procedure ended with percutaneous endoscopic gastrostomy for enteral nutrition. The patient was followed up to evaluate the size reduction of the fistula. Cough, backache, and fever were alleviated within a week. Forty-five days after the surgery, endoscopic examination showed that the fistulas were reduced in size. The larger one reduced from 0.5 cm to 0.2 cm, while the smaller one was fully closed. CONCLUSION Transplantation of a pedicle flap obtained from the esophageal mucosa endoscopically is minimally invasive for the treatment of fistula.