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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
0013-726X
1438-8812
Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

10.1055/a-2410-3349
E-Videos-2024-06-5142-EV
E-Videos
Unblocking a terminolateral anastomosis on an interposed coloplasty for caustic esophagitis: placement of a lumen-apposing metal stent to straighten the lumen
Pioche Mathieu MD, PhD
http://orcid.org/0000-0003-1744-6036
Lafeuille Pierre Dr.
Burgevin Alice Dr.
http://orcid.org/0000-0002-5002-0486
Schaefer Marion Dr.
Monneuse Olivier Dr.
Rivory Jérôme Dr.
Lupu Alexandru Dr.
1 Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
2 Gastroenterology and Endoscopy Unit, Brabois University Hospital, Nancy, France
3 Digestive Surgery Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
Correspondence Mathieu Pioche, MD, PhD Endoscopy Unit, Department of Digestive Diseases, Pavillon L – Edouard Herriot Hospital69437 Lyon CedexFranceMathieu.pioche@chu-lyon.fr
19 9 2024
12 2024
1 9 2024
56 Suppl 1 E786E787
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmcThe management of caustic esophagitis is complex and is generally carried out in an emergency situation where the prognosis is life threatening.

When esophageal necrosis is major, one of the surgical solutions is esophageal stripping followed by interposition coloplasty with cervical anastomosis 11 . This coloplasty is usually termino-terminal, but sometimes, if the colonic transplant is too long, a termino-lateral anastomosis is chosen to avoid recutting the transplant and shortening it too much.

In the case presented here, a terminolateral anastomosis had to be performed and was complicated by a transcutaneous cervical anastomotic fistula. During examinations with opacification, the contrast product filled the pseudo diverticular aspect of the end of the transplant ( Fig. 1Fig. 1 a , Video 1Video 1 ) without opacifying the lumen of the underlying coloplasty, with subsequent leakage of the contrast into the cervical fistula.

Fig. 1 Fig. 1 Schematic description of the procedure. a Initial aspect with “stricture” of the main lumen of the coloplasty, with diverticular shape of the terminolateral anastomosis with cervical fistula. b Placement of a lumen-apposing metal stent between the terminal part of the coloplasty and the main lumen. c Mucosal bridge section remaining after removal of the stent. d Final aspect after section of the spur.

Terminolateral anastomosis obstruction on an interposed coloplasty for caustic esophagitis: lumen-apposing metal stent anastomosis to straighten the lumen.

Video 1

Video 1

In view of this pseudo diverticulum with spur obstruction, we opted to place a 20-mm lumen-apposing metal stent (LAMS; Axios; Boston Scientific, Marlborough, Massachusetts, USA) between the lateral termination and the lumen of the colonic graft to re-establish a straighter lumen ( Fig. 1Fig. 1 b ). This allowed the fistula to dry out immediately after the procedure and the patient could resume liquid feeding.

After removal of the LAMS 3 months later, the fistula had completely dried and we sectioned the residual mucosal spur that had developed around the prosthesis ( Fig. 1Fig. 1 c ). On final opacification, esophageal passage was normal with no leakage or obstruction. There was no recurrence of the fistula in the following month and no eating disorders were noted ( Fig. 1Fig. 1 d ).

As previously described for strictures 22 , LAMS could be an effective treatment to straighten the way between the lateral pouch and the lumen to remove the obstruction and treat the fistula in terminolateral anastomotic disorders.

Endoscopy_UCTN_Code_TTT_1AO_2AZ

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E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .

Conflict of Interest The authors declare that they have no conflict of interest.
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References

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2 Sonthalia N Tewari A Patil V Novel application of lumen-apposing metal stent for management of malignant recto-sigmoid stricture with fistula VideoGIE 2024 9 298 301 38887738
