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ENDOSCOPIC REPAIR OF A GASTROPLEURAL FISTULA USING A GASTRIC MUCOSAL PATCH GRAFT

SS Dhalla, D Thompson
GI unit, Brandon Regional Health Center, Brandon, Manitoba

Gastropleural Fistula is one of the most dreaded complication post esophagectomy causing major morbidity and mortality. We describe a case report in a patient who underwent this procedure and developed this complication. This fistula was repaired using a gastric mucasal graft harvested and applied to the fistula, using Tisseel^TM, a human fibrin sealant , and Endoscopically placed Endo-clips.
METHODS: Gastric mucosal patch was harvested using standard endoscopic resection techniques, by lifting the mucosa with saline-epinephrine solution, and harvesting it as a polyp with an endoscopic polypectomy snare. After freshening the graft site with a cytology brush and cleansing with saline solution, the graft was placed at the defect site, and tacked to the edges of the wound with Endo-Clips. Further sealing was carried out with the fibrin Sealant Tisseel.
RESULTS: Post Operative gastrograffin swallow showed complete resolution of the fistula, allowing removal of chest tube and start of oral feedings.
CONCLUSION: This method of closure of a complicated fistula is easily done with the available technology and should be considered before open surgical options are considered. This will hopefully decrease the morbidity and mortality associated with these fistulas.

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