Use of endoscopic nasobiliary drainage tube for treating mediastinitis caused by insertion of an esophageal self-expanding metal stent.

relatively easy to deploy, with a high technical success rate, and provide rapid relief of dysphagia [1], which is the major factor affecting quality of life in patients not suitable for resection. Since Domschke et al. first reported the use of SEMS in 1990 [2], the technique has been widely used for malignant esophageal stenosis [3], although there have been many reports of complications associated with the combination of SEMS and chemoradiation therapy (CRT) [4,5]. A 56-year-old man was diagnosed as having carcinoma of the lower esophagus in July 2008. After CRT, he was admitted to our hospital for second-line chemotherapy in October 2008. The patient had developed uncontrollable salivation in the month prior to admission. A SEMS was placed successfully, but he developed fever and low blood pressure on November 28, 2008. Computed tomography (CT) examination revealed a fistula between the esophagus at the oral end of the SEMS and the mediastinum, and mediastinitis was suspected. Despite the administration of antibiotics, and steroid pulse and γ-globulin combination therapy, an abscess with liquefaction was confirmed in the mediastinum 7 days later (●" Fig. 1). An endoscopic nasobiliary drainage (ENBD) tube was placed in the mediastinal abscess along a guide wire to allow drainage (●" Fig. 2). A CT scan demonstrated improvement in the abscess 12 days after insertion of the ENBD tube (●" Fig. 3). The risks and benefits of SEMS insertion must be weighed in light of the existing illness and the patient’s quality of life. We report the case of a patient with esophageal carcinoma treated with CRT who developed mediastinitis after SEMS insertion. Mediastinitis was treated by esophago-mediastinal drainage of the mediastinal abscess via the insertion of an ENBD tube. This technique has not been previously reported, but appears to represent a useful method for management of mediastinitis after SEMS insertion.