Takahashi N, Baba S, Toya Y, Nikai H, Fujisawa R, Endo F, Umemura A, Iwaya T, Nitta H, Sasaki A. Curative endoscopic closure of a chronic esophagopleural fistula after Boerhaave syndrome using an over-the-scope clip: A case report. World J Gastrointest Surg 2026; 18(8): 121170 [DOI: 10.4240/wjgs.121170]
Corresponding Author of This Article
Naoto Takahashi, MD, PhD, Assistant Professor, Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun 028-3695, Iwate, Japan. takanao@iwate-med.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
case-report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Takahashi N, Baba S, Toya Y, Nikai H, Fujisawa R, Endo F, Umemura A, Iwaya T, Nitta H, Sasaki A. Curative endoscopic closure of a chronic esophagopleural fistula after Boerhaave syndrome using an over-the-scope clip: A case report. World J Gastrointest Surg 2026; 18(8): 121170 [DOI: 10.4240/wjgs.121170]
Naoto Takahashi, Shigeaki Baba, Haruka Nikai, Ryosuke Fujisawa, Akira Umemura, Hiroyuki Nitta, Akira Sasaki, Department of Surgery, Iwate Medical University School of Medicine, Shiwa-gun 028-3695, Iwate, Japan
Yosuke Toya, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa-gun 028-3695, Iwate, Japan
Fumitaka Endo, Takeshi Iwaya, Department of Clinical Oncology, Iwate Medical University School of Medicine, Shiwa-gun 028-3695, Iwate, Japan
Author contributions: Takahashi N and Baba S contributed to the conception and design of the study; Takahashi N drafted the manuscript; Toya Y and Nikai H performed the endoscopic procedure and contributed to clinical management; Fujisawa R, Endo F, and Umemura A collected and interpreted the clinical data; Iwaya T, Nitta H, and Sasaki A supervised the study and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.
AI contribution statement: The author acknowledges the use of ChatGPT, developed by OpenAI, to assist with English language editing during the manuscript preparation process. The software was used solely to improve the clarity, grammar, and readability of the text. No part of the manuscript, including data collection, interpretation, or scientific content, was generated by AI.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Naoto Takahashi, MD, PhD, Assistant Professor, Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun 028-3695, Iwate, Japan. takanao@iwate-med.ac.jp
Received: March 18, 2026 Revised: April 10, 2026 Accepted: June 4, 2026 Published online: August 27, 2026 Processing time: 152 Days and 15.9 Hours
Abstract
BACKGROUND
Spontaneous esophageal rupture (Boerhaave syndrome) remains a life-threatening condition associated with high mortality rates. In recent years, various treatment strategies for it, including conservative and endoscopic approaches, have been increasingly reported. However, chronic esophagopleural fistula developing after conservative management is often difficult to treat, and no standard therapeutic strategy for it has been established. We report a case of a refractory chronic esophagopleural fistula successfully treated using an over-the-scope clip (OTSC).
CASE SUMMARY
A 65-year-old man underwent conservative management of spontaneous esophageal rupture and was initially discharged after clinical improvement. Subsequently, he experienced recurrent left-sided pneumonia and empyema. Approximately 1 year after onset, he was diagnosed with a refractory esophagopleural fistula and referred to our department. Because of severe bilateral emphysema, surgical intervention was considered high-risk, and endoscopic treatment was selected. Endoscopy revealed a 2 mm fistulous opening on the left wall just above the esophagogastric junction. The fistula was successfully closed using a single OTSC. Contrast esophagography performed on postoperative day 14 confirmed complete closure, and no recurrence of empyema was observed during 1-year follow-up.
CONCLUSION
OTSC can effectively treat refractory chronic fistulas developing after spontaneous esophageal rupture in patients for whom surgical intervention is high-risk.
Core Tip: The development of a chronic esophagopleural fistula following conservative management of Boerhaave syndrome is rare, such fistulas are difficult to treat, particularly in patients who are poor candidates for surgical intervention. We report a case in which a small chronic esophagopleural fistula was successfully closed using an over-the-scope clip combined with adequate pleural drainage and infection control. This case suggests that with appropriate patient selection and comprehensive management, over-the-scope clip can provide a minimally invasive and effective treatment option for chronic esophageal fistulas in high-risk surgical candidates.
