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.