Successful Endoscopic Closure of Gastrobronchial Fistula Using Polyglycolic Acid Sheets with Fibrin Glue

The patient was 72-year-old when she presented with pneumonia. She has a history of esophageal cancer and had undergone subtotal esophagectomy with reconstruction by a thoracic esophagogastric tube anastomosis 17 years before. Computed tomography revealed localized thinning of the gastric tube adjacent to a pulmonary consolidation (Figure A). Esophagogastroduodenoscopy revealed an ulcer in the gastric tube and a gastrobronchial fistula (Figure B). Because of poor overall health, surgical risk was believed to be prohibitive, and we sought endoscopic treatment options. We attempted endoscopic filling of the defect with polyglycolic acid (PGA) sheets (Neoveil, Gunze, Osaka, Japan). Using grasping forceps, we placed 3 PGA sheets of 15 mm × 15 mm endoscopically on the perforation site and applied fibrin glue as a seal around the sheets (Figure C). On follow-up 27 months later, the perforation site was well healed, resembling an ulcer scar (Figure D). PGA sheets, which are biodegradable and can be substituted for sutures, have mainly been used to cover surgical wounds. Using PGA sheets to achieve endoscopic closure of fistulas between the gastrointestinal tract and other organs is not yet well established. This case highlights that endoscopic use of PGA sheets could be a safe and effective option for managing fistulas in the gastrointestinal tract.