Pleural connection treated with stent plus endobronchial valve.

BACKGROUND AND AIMS: Esophago-pleural fistula (EPF) is a rare but serious condition associated with high morbidity and mortality. Surgical repair remains the standard treatment; however, many patients are not surgical candidates. Endoscopic management, including clips, stents, and vascular plugs, have shown limited success, particularly for chronic fistulas.

METHODS

A 34-year-old male with a history of sleeve gastrectomy complicated by gastrobronchial fistula underwent Roux-en-Y esophagojejunostomy and later developed a refractory EPF.

RESULTS

Initial management with endoscopic and bronchoscopic placement of an endobronchial valve within a biliary metal stent was successful. Follow-up endoscopy revealed a persistent 6-mm fistula, prompting placement of an 8 mm × 6 cm fully covered biliary stent. A size 9 endobronchial valve was deployed within the stent using fluoroscopic and endoscopic guidance and functioning as a 1-way valve. This technique facilitated gradual decompression of the abscess cavity. At 6 months, imaging confirmed fistula resolution, and the stent with the valve was removed.

CONCLUSIONS

For nonsurgical candidates with EPF, endoscopic and bronchoscopic management provides a viable alternative. This novel approach of valve deployment within a stent offers a promising, minimally invasive solution for refractory cases.