Secondary esophageal stricture after successful closure of a benign esophago-pleural fistula managed with a Polyester stent: case report

 P. Marques, I Alves

  

Resumo

Descreve-se um caso clínico de encerramento com sucesso de uma fistula esofago-pleural benigna com recurso a uma prótese de Polyflex. Um mês após remoção da prótese o doente referiu disfagia, identificando-se uma estenose no local prévio de localização da prótese. Após dilatação e injecção de corticoide intra-parietal verificou-se a sua resolução. As prótese de Polyflex têm uma utilização crescente em patologia benigna do esófago (estenoses, fistulas ou perfuração). Estenoses secundárias após a sua remoção não foram previamente descritas.

 

 Summary

We report a case of successful closure of a benign esophago-pleural fistula with a Polyflex stent. One month after stent retrieval the patient developed dysphagia and a stricture was noted at the previous stent location. After esophageal dilation and steroid injection the stricture resolved. The new Polyflex stent is increasingly being used to manage benign esophageal diseases such as strictures, fistulas or perforation. Secondary esophageal strictures have not been previously reported.

 

 

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 Bibliografia

1. Siersema P. Treatment of esophageal perforations and anastomotic leaks: the endoscopist is stepping into the arena. Gastrointest Endosc 2005; 61: 897-900.        [ Links ]

2. Chertow GM, Marcantonio ER, Wells RG. Saccharomyces cerevisiae empyema in a patient with esophago-pleural fistula complicating variceal sclerotherapy. Chest 1991; 99: 1518-9.

3. Andersson R, Nilsson S. Perforated Barrett’s ulcer with esophagopleural fistula. A case report. Acta Chir Scand 1985; 151: 495-6.

4. Roufail WM, Brice BS Jr. Esophago-pleural fistulae secondary to perforated esophageal ulcer. Gastrointest Endosc 1972; 18: 165-6

5. Ackroyd R, Watson DI, Devitt PG et al. Expandable metallic stents should not be used in the treatment of benign esophageal strictures. J Gastroenterol Hepatol 2001; 16: 484-7.

6. Sandha G, Marcon N. Expandable metal stents for benign esophageal obstruction. Gastrointest Endosc Clin N Am 1999; 9:437-46.

7. Lee HJ, Hsu R, Leung JW. Are self-expanding metal mesh stents useful in the treatment of benign esophageal stenoses and fistula? An experience in four cases. Am J Gastroenterol 2000; 95:1920-5

8. Costamagna G, Shah SK, Tringali A, et al. Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures. Surg Endosc 2003; 17: 891-5.

9. Dormann AJ, Eisendrath P, Wigginghaus B et al. Palliation of esophageal carcinoma with a new self-expanding plastic stent. Endoscopy 2003; 35: 207-11.

10. Decker P, Lippler J, Decker D, et al. Use of the polyflex stent in the palliative therapy of esophageal carcinoma: results in 14 cases and review of the literature. Surg Endosc 2001; 15: 1444-7.

11. Radecke K, Gerken G, Treichel U. Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc 2005; 61: 812-8.

12. Petruzziello L, Tringali A, Riccioni ME, et al. Successful early treatment of Boerhaave’s syndrome by endoscopic placement of a temporary self-expandable plastic stent without fluoroscopy. Gastrointest Endosc 2003; 58: 608-12.

13. Repici A, Romagnoli R, Reggio D, et al. Successful closure of a postsurgical benign esophagomediastinal fistula by temporary placement of a polyester expandable stent: case report and review. Gastrointest Endosc 2002; 56: 747-50.

14. Adler DG, Pleskow DK. Closure of a benign tracheoesophageal fistula by using a coated, self-expanding plastic stent in a patient with a history of esophageal atresia. Gastrointest Endosc 2005;61: 765-8.

15. Dormann AJ, Wigginghaus B, Deppe H, et al. Successful treatment of esophageal perforation with a removable self-expanding plastic stent. Am J Gastroenterol 2001; 96: 923-4.

16. Gelbmann CM, Ratiu NL, Rath HC, et al. Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy 2004; 36: 695-9

17. Langer FB, Wenzl E, Prager G et al. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 2005; 79: 398-403.

18. Schubert D, Scheidbach H, Kuhn R, et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005;61: 891-6.

19. Muldner A, Reinshagen K, Wustner M, et al. Modified selfexpanding plastic stent for the treatment of refractory benign esophageal strictures. Endoscopy 2005; 37: 925.

20. Garcia-Cano J. Esophageal insertion of polyflex stents without fluoroscopy in peptic strictures. Endoscopy 2005; 37: 400.

 

Correspondência:

 Pedro Pinto Marques, MD

Serviço de Gastrenterologia – Unidade de Endoscopia

Hospital São Francisco Xavier, SA

Estrada Forte do Alto do Duque

1449-005 Lisboa

Portugal

e-mail: pedromarq@hotmail.com

 

Endoscopy Unit, Hospital São Francisco Xavier, SA, Lisbon, Portugal.

 

Recebido para publicação: 17/01/2006

Aceite para publicação: 17/05/2006