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Background: Treatment of anastomotic leakage in reconstruction after esophagectomy remains challenging. This report presents a new endoscopic filling method for persistent fistula after failure of conservative treatment of leakage caused by anastomotic insufficiency., Methods: 10 of 14 patients, in whom post-esophagectomy leakage had failed to resolve after 2 weeks of conservative treatment, underwent endoscopic filling with polyglycolic acid (PGA) sheet and fibrin glue into the anastomotic leakage site, using a delivery tube and endoscopic catheter, respectively., Results: Each patient underwent jejunostomy, to secure nutrition. The leakage was resolved in all 10 patients. The mean number of PGA - fibrin glue procedures was 1.7. The mean period from the first application to the resumption of oral intake was 31.6 days, from the final application it was 14.7 days., Conclusions: The reported filling method offers a new endoscopic approach for persistent fistula after esophagectomy when conservative treatment of leakage has failed., Competing Interests: The authors declare no conflicts of interest., (Thieme. All rights reserved.)

Background Esophagorespiratory fistulas including esophagopulmonary fistulas occur in 5–10% patients with esophageal cancer with invasion to adjacent organs. With an esophagorespiratory fistula, saliva and food flow into the respiratory tract through the fistula and severe pneumonia or lung abscess can develop. Alternatively, whether chemoradiotherapy can be performed for patients with esophagorespiratory fistulas affects the further outcomes of treatment in these patients. An esophageal cancer patient with an esophagopulmonary fistula who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and whose inflammation from the esophagorespiratory fistula could be effectively controlled, which facilitated the prompt administration of definitive chemoradiotherapy, is reported. Methods Case report: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, urgent CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer, infiltrative shadows in the peripheral lung field, and a pleural effusion. Due to the esophagopulmonary fistula, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy on the right and left supraclavicular region and enterostomy (drainage tube-less esophageal separation surgery). Results Antibiotic drug therapy for pneumonia and lung abscess achieved a favorable outcome. Definitive chemoradiotherapy for the esophageal cancer was started from postoperative day 25. Radiotherapy could not be completed because of sepsis due to aspiration pneumonia, though the aspiration pneumonia improved with intensive treatment. At six-month follow-up, the patient had achieved relapse-free survival and is currently symptom-free. Conclusion Separation surgery with a drainage tube-less (DRESS) esophagostomy is the less invasive operative procedure, which allows prompt initiation of chemoradiotherapy. In many cases of esophageal surgeries, an external esophagostomy is made with a drainage tube, and drainage tubes sometimes cause trouble and affect the quality of life of patients after surgery. However, our drainage tube-less (DRESS) esophagostomy might improve patient's quality of life. In addition, evaluation of esophageal cancer by endoscopic examination through the esophagocutaneostomy can be easily performed. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Treatment of anastomotic leakage in the reconstruction after esophagectomy remains a challenge. Secure treatment method has been established and there is very few clinical studies. Although internal drainage using nasogastric tube has been reported recently. In this report, the authors present endoscopic filling method (EFM) for anastomotic leakage. Methods Six patients (five males and one female) with anastomotic leakage whose ages ranged from 54 to 77 were includes in this study. The patients underwent EFM and the anastomotic leakage was filled with polyglycolic acid sheets and fibrin glue endoscopically. Initially, tube drainage was performed, and this treatment was performed as the secondary treatment, when the improvement was not made by tube drainerge. Results Every patient had a jejunostomy, with any concern for nutrition. Abscess was present in all patients, but external drainerge was not required. EFM was required once to five times until the fistulas cured. There was no motality. There are no cases of relapse after discharge from the hospital. Three of them cured in the first treatment, it takes average 26 days from esophagectomy to starting oral intake. This method allows us to repair for all fistula with regardless of inflammation or infection. Conclusion In conclusion, the patients with reflactly esophagogastric anastomotic leakage after esophagectomy would be better served by EFM. Further study is required larger series of patients and a longer follow-up period to examine the safety and effectiveness of EFM. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]