Endoscopic treatment of a recalcitrant esophageal fistula with new tools: stents, Surgisis, and nitinol staples (with video).

Intrathoracic esophageal anastomotic leaks are a feared complication of esophageal surgery. Beyond surgical drainage, therapeutic endoscopic intervention is increasingly indicated to effect closure of acute perforations, leaks, and fistulae. Conventional endoscopic clips and self-expanding stents are in the front line of endoscopic therapy, but even with these standard approaches, healing may remain elusive. This case report describes the use of two complementary secondary closure methods, Surgisis Soft Tissue Graft (Cook Biotech Inc, West Lafayette, IN) and the Over-The-Scope- Clipping system (OTSC system; Ovesco Endoscopy GmbH, Tuebingen, Germany) to resolve a recalcitrant esophageal fistula.