An endoscopic salvage procedure for the treatment of regurgitation occurring after an unsuccessful esophagectomy with gastric tube reconstruction and subsequent colonic bypass surgery.

esophagectomy are associated with high morbidity and mortality [1,2]. We pres− ent here a patient who had a subtotal esophagectomy with gastric interposition because of esophageal adenocarcinoma. Anastomotic leakage occurred and was treated by endoscopic applications of fi− brin glue. One month after discharge she presented with a large (2.5 cm ” 5 cm) ia− trogenic esophagotracheal fistula. Be− cause of the extensive defect in the pars membranacea and the inflammation we decided against surgical intervention and treated the defect endoscopically using a combination of a Vicryl plug and fibrin glue, as described previously [3]. The tra− cheal fistula was treated with a covered self−expanding tracheal stent [4]. Despite repeated endoscopic dilations, the stenosis recurred due to ischemia. Ad− ditional stenting of the anastomotic ste− nosis was impossible because there was only a thin tissue bridge between the pars membranacea and the (neo−)esoph− agus and because a stent−to−stent ar− rangement would most probably have led to further necrosis. The presence of the nasojejunal tube caused considerable psychological stress and impaired the pa− tient’s quality of life. To enable her to re− commence oral feeding, ascending colo− nic bypass surgery with collar side−to− side esophagocolostomy and intra−ab− dominal side−to−side colojejunostomy was performed 11 months after the initial operation, leaving the gastric bypass in situ. The endoscopic control showed a wide anastomosis of the esophagocolos− tomy, but a siphon−like reservoir at the stenotic entrance of the gastric interposi− tion led to regurgitation (l" Fig. 1, 2). We therefore performed an endoscopic clo− sure of the esophagogastric anatomosis, with de−epithelialization of the stenotic gastric tube and sealing with bucrylate and histoacrylate. Control radiography showed adequate efflux without filling of the sealed gastric tube (l" Fig. 3). She was able to resume normal oral feeding and her body weight stabilized. This endo− scopic approach has not been described in the published literature before. It re− presents a useful alternative for the treat− ment of this serious clinical situation. Endoscopy_UCTN_Code_TTT_1AO_2AI