Esophagobronchial fistula complicated by esophageal achalasia treated by per-oral endoscopic myotomy
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CASE REPORT
Esophagobronchial fistula complicated by esophageal achalasia treated by per‑oral endoscopic myotomy Tatsuro Sugaya1 · Takuto Hikichi2 · Jun Nakamura1,2 · Minami Hashimoto1,2 · Mika Takasumi1 · Tsunetaka Kato1,2 · Ryoichiro Kobashi1 · Tadayuki Takagi1 · Rei Suzuki1 · Mitsuru Sugimoto1 · Yuki Sato1 · Hiroki Irie1 · Mami Rikimaru3 · Manabu Uematsu3 · Hiroyuki Minemura3 · Masao Kobayakawa4 · Hiromasa Ohira1 Received: 22 June 2020 / Accepted: 30 August 2020 © Japanese Society of Gastroenterology 2020
Abstract A 48-year-old man who underwent balloon dilation for esophageal achalasia more than 20 years prior developed severe dysphagia and cough during mealtimes. Endoscopic findings showed a markedly dilated esophagus with residue, narrowing of the esophagogastric junction (EGJ), and a fistula in the middle thoracic esophagus. Esophagography showed narrowing of the EGJ and outflow of contrast from the esophagus to the bronchus. In addition, computed tomography showed marked esophageal dilatation and diffuse granular shading in both lungs. Based on these imaging findings, the patient was diagnosed with deterioration of esophageal achalasia and an esophagobronchial fistula (EBF) secondary to achalasia. The increased intra-esophageal pressure caused by the achalasia was suspected to have inhibited the closure of the EBF. Therefore, we believed that per-oral endoscopic myotomy (POEM) would help treat the achalasia and simultaneously contribute to closing of the EBF. Immediately after POEM, the dysphagia and cough improved. Furthermore, the EBF was closed. 14 months after POEM, the patient did not exhibit deterioration of esophageal achalasia and EBF. To the best of our knowledge, there have been no reports of POEM implemented in cases of esophageal achalasia complicated by EBF. Therefore, this case is worth reporting. Keywords Balloon dilation · Esophageal achalasia · Esophageal stenosis · Esophagobronchial fistula · Per-oral endoscopic myotomy
Introduction
Tatsuro Sugaya and Takuto Hikichi are co-first authors. * Takuto Hikichi [email protected] 1
Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
2
Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan
3
Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
4
Department of Medical Research Center, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
An esophagobronchial fistula (EBF) is a rare disease in which a fistula develops between the esophagus and bronchus; this may be congenital or acquired. The causes of acquired EBFs have been reported to be associated with malignant diseases, such as esophageal and lung cancers, accounting for 20% of all EBFs [1]. The causes of EBFs related to nonmalignant diseases include infectious factors, such as tuberculosis [2]; traumatic factors, such as traffic accidents; and iatrogenic factors, such as esophageal stent placement,
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