Rendezvous technique using bronchoscopy and gastroscopy to close a tracheoesophageal fistula by placement of an over-the-scope clip

Abstract

A 23-year-old man with polytrauma was admitted to the intensive care unit for level 3 postoperative support. His medical history included VATER syndrome [1] with corrective surgery for the tracheoesophageal fistula (TEF). Ventilatory support according to ARDSNet criteria in the acute phase was complicated by a persistent air leak and significant gastric distension, raising the possibility of a residual TEF. An initial gastroscopy failed to show a fistulous opening. A Ryle's tube for gastric air drainage and nasojejunal tube for enteral feeding were left in situ. Flexible bronchoscopy through the endotracheal tube showed a flap with access to the esophagus from the bronchial tree just above the carina, confirming the clinical suspicion of a TEF.