Refractory esophageal-mediastinal fistula successfully treated with endoluminal vacuum therapy and enteral nutrition using a double-lumen elemental diet tube: a case report

Background: Aortic-esophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) has a high fatality rate and is difficult to treat. Endoluminal vacuum therapy (EVT) has recently appeared and proven to be a useful method for anastomotic leakage.

Case presentation: A 76-year-old man underwent aortic arch replacement for a stent graft infection after TEVAR. Persistent mediastinitis and pyothorax were observed after aortic arch replacement, and further examination revealed an esophageal-mediastinal fistula (EMF). Over-the-scope clip (OTSC^®) closure was performed to treat EMF but achieved no cure. Then, the patient was referred to our hospital. First, we removed the OTSC^® that interfered with the treatment using the remOVE System^® and started EVT using a double-lumen elemental diet tube (W-EDT^®). The vacuum sponge was affixed to the vacuum side of W-EDT^®, and enteral nutrition administered through W-EDT was combined with EVT. EMF was cured 11 days after EVT, and the patient was able to feed himself.

Conclusion: The combination of EVT and enteral nutrition feeding using W-EDT® is a successful novel procedure to treat refractory EMF.