World Congress at ACG2017

Symposium 2D: Live From Orlando! The 5th Annual Endoscopy Video Forum

V3 - Transtracheal Cyanoacrylate Glue Injection for the Management of Malignant Tracheoesophageal Fistula

Monday, October 16
5:21 PM - 5:28 PM
Location: W414 (Level 4)

Please note that Dr. Malay Sharma will present this video.




Category: Endoscopy Video Forum       Sub-Category: Transtracheal use of cyanoacrylate glue ACG.mp4

Piyush Somani, MBBS, MD, DM, Malay Sharma, MBBS, MD, DM, Saurabh Jindal, MBBS, MD, DM
Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
Introduction: Malignant tracheoesophageal fistula (TEF) is a devastating complication of esophageal cancer, lung cancer or other carcinoma associated with high mortality, short survival, and poor quality of life. Covered metallic stents placement either in trachea/esophagus or both are used for the palliative treatment. Other endoscopic modalities rarely attempted for benign and malignant TEF includes use of over the scope clip, transesophageal glue injection, electrocautery and laser.

Case description: A 56-year-old man presented with complain of intractable cough on swallowing for last 3 months. He had completed a course of chemo radiotherapy for carcinoma of middle one third of the oesophagus four months back. The upper gastrointestinal endoscopy showed a stricture with superficial ulceration at 23 cm from lower incisor in the oesophagus. A small (~ 4 mm diameter) fistula was noted just above the stricture. Application of over-the-scope clip was failed. A hydrophilic guide wire (0.032” inches diameter) was placed through the ERCP cannula into the fistula. Bronchoscopy revealed the presence of guidewire coming out from a fistulous tract in the posterior wall of the trachea above the tracheal bifurcation. The guide wire was grasped with a biopsy forceps. The guide wire was removed along with the scope from the mouth. The fluoroscopic image showed a curved course (length of the fistula was about 2.5 cm) of the guide wire. After assessment of the fistula by the track of the guidewire, two routes of glue injection were considered, Trans-tracheal and Trans-esophageal. Transesophageal route was considered risky due to an expected spillage of the glue within the trachea. Hence, the option of transtracheal glue injection was selected. The cannula and the scope were reintroduced through the trachea. The presence of the markers on the cannula were used to assess the depth of insertion of cannula within the fistula and to plan the site of injection of the glue.1 ml of cyanoacrylate glue was injected while pulling the cannula out. 1 ml of distilled water was injected while pulling out the rest of the cannula to the tip of the fistula. After one hour, the patient started swallowing liquids without any cough. Patient has remained asymptomatic till now.

Conclusion: Transtracheal glue placement may be safer than transoesophageal glue placement. This appears to be first report of transtracheal glue injection of malignant TEF.

 

Supported by Industry Grant: Yes


Arrow showing the location of fistula
Hydrophilic wire inserted into the fistula
Fluoroscopy image showing the curved course of wire in fistula

Citation: . TRANSTRACHEAL CYANOACRYLATE GLUE INJECTION FOR THE MANAGEMENT OF MALIGNANT TRACHEOESOPHAGEAL FISTULA. Program No. V3. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Piyush Somani

Jaswant Rai Speciality Hospital, Saket, Meerut
Meerut, Uttar Pradesh, India

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