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Esophagobronchial fistula complicated by esophageal achalasia treated by per-oral endoscopic myotomy

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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.

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Acknowledgements

We wish to express our deep appreciation to all endoscopy medical staff for their assistance with the endoscopic procedures.

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Author notes

  1. Tatsuro Sugaya and Takuto Hikichi are co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan

    Tatsuro Sugaya, Jun Nakamura, Minami Hashimoto, Mika Takasumi, Tsunetaka Kato, Ryoichiro Kobashi, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie & Hiromasa Ohira

  2. Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan

    Takuto Hikichi, Jun Nakamura, Minami Hashimoto & Tsunetaka Kato

  3. Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan

    Mami Rikimaru, Manabu Uematsu & Hiroyuki Minemura

  4. Department of Medical Research Center, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan

    Masao Kobayakawa

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  1. Tatsuro Sugaya
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Contributions

This report was conceptualized and designed by TS and TH. POEM was conducted by JN, MH, and TS. Patient management before and after POEM was carried out by TS, JN, MH, MT, TK, RK, TT, RS, MS, YS, and HI. Bronchoscopies were carried out by HM, MR, and MU. The first draft of the manuscript was written by TS, TH, and JN. MK and HO provided advice on the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Takuto Hikichi.

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Conflict of interest

Tatsuro Sugaya, Takuto Hikichi, Jun Nakamura, Minami Hahimoto, Mika Takasumi, Tsunetaka Kato, Ryoichiro Kobashi, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Mami Rikimaru, Manabu Uematsu, Hiroyuki Minemura, Masao Kobayakawa, and Hiromasa Ohira declare that they have no conflict of interest.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from this patient for being included in the paper.

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Sugaya, T., Hikichi, T., Nakamura, J. et al. Esophagobronchial fistula complicated by esophageal achalasia treated by per-oral endoscopic myotomy. Clin J Gastroenterol 13, 1051–1056 (2020). https://doi.org/10.1007/s12328-020-01226-0

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  • DOI: https://doi.org/10.1007/s12328-020-01226-0

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