Kawagoe Ryosuke, Narasaka Toshiaki, Mamiya Takashi, Nishi Masaaki, Tsuchiya Kiichiro
Department of Gastroenterology Institute of Medicine University of Tsukuba Ibaraki Japan.
Graduate School of Comprehensive Human Sciences University of Tsukuba Ibaraki Japan.
DEN Open. 2025 Sep 2;6(1):e70202. doi: 10.1002/deo2.70202. eCollection 2026 Apr.
Aortoesophageal fistula (AEF) is a rare but life-threatening condition. Initial management typically includes thoracic endovascular aortic repair (TEVAR) or aortic graft replacement to achieve hemostasis, followed by esophagectomy with aortic graft replacement and greater omentum wrapping to eliminate the source of infection. We report a case of successful endoscopic closure of a chronic esophageal fistula secondary to AEF. A 63-year-old man presented with hematemesis. He had a history of two ascending aortic replacements and one descending aortic replacement for aortic dissection. Computed tomography revealed a pseudoaneurysm at the graft anastomosis site and perforation into the esophagus. He was diagnosed with AEF and underwent TEVAR for hemostasis. Although the bleeding was stopped, follow-up imaging confirmed a residual fistula. Because of his poor general condition, surgery was contraindicated, and endoscopic closure was attempted. Initial treatment with hemostasis clips was ineffective. A second attempt using polyglycolic acid sheets, fibrin glue, and hemostasis clips with endoscopic submucosal dissection (ESD) achieved closure, but the fistula reopened after 5 months. Finally, the combination of ESD and over-the-scope clip (OTSC) achieved complete and sustained closure. The patient was discharged after 3 months but died 8 months postoperatively owing to idiopathic splenic rupture. This case demonstrates that the combination of ESD and OTSC may be an effective treatment option for chronic esophageal fistulas caused by AEF.
主动脉食管瘘（AEF）是一种罕见但危及生命的疾病。初始治疗通常包括胸主动脉腔内修复术（TEVAR）或主动脉移植置换术以实现止血，随后进行食管切除术并置换主动脉移植物以及大网膜包裹以消除感染源。我们报告一例成功通过内镜闭合继发于AEF的慢性食管瘘的病例。一名63岁男性因呕血就诊。他有因主动脉夹层行两次升主动脉置换和一次降主动脉置换的病史。计算机断层扫描显示移植物吻合部位有假性动脉瘤并穿孔至食管。他被诊断为AEF并接受TEVAR以止血。尽管出血停止，但后续影像学检查证实仍有残余瘘。由于他的全身状况较差，手术禁忌，因此尝试内镜闭合。最初使用止血夹治疗无效。第二次尝试使用聚乙醇酸片、纤维蛋白胶和止血夹并结合内镜黏膜下剥离术（ESD）实现了闭合，但瘘在5个月后再次开放。最后，ESD和套扎器（OTSC）联合使用实现了完全且持久的闭合。患者在3个月后出院，但术后8个月因特发性脾破裂死亡。该病例表明，ESD和OTSC联合使用可能是治疗由AEF引起的慢性食管瘘的有效治疗选择。
