Nunes BCM, Rocha RSP, Berzin TM, Franco MC, Kum AST. Staged multimodal endoscopic vacuum therapy for a complex gastro-pleuro-broncho-cutaneous fistula: A case report. World J Clin Cases 2026; 14(5): 117850 [DOI: 10.12998/wjcc.v14.i5.117850]
Corresponding Author of This Article
Angelo So Taa Kum, MD, Senior Researcher, Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo 05403-010, Brazil. angelo.kum@alumni.usp.br
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/
World J Clin Cases. Feb 16, 2026; 14(5): 117850 Published online Feb 16, 2026. doi: 10.12998/wjcc.v14.i5.117850
Staged multimodal endoscopic vacuum therapy for a complex gastro-pleuro-broncho-cutaneous fistula: A case report
Beanie Conceição Medeiros Nunes, Rodrigo Silva de Paula Rocha, Tyler M Berzin, Matheus Cavalcante Franco, Angelo So Taa Kum
Beanie Conceição Medeiros Nunes, Rodrigo Silva de Paula Rocha, Angelo So Taa Kum, Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Sao Paulo 05403-010, Brazil
Tyler M Berzin, Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
Matheus Cavalcante Franco, Division of Gastroenterology, UT Health San Antonio, San Antonio, TX 78229, United States
Author contributions: Nunes BCM and Kum AST designed the conceptualization and performed the original draft; Kum AST and Rocha RSP performed the endoscopic procedures and the data collection; Berzin TM and Franco MC reviewed the article; all authors participated in the writing, editing and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
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).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Angelo So Taa Kum, MD, Senior Researcher, Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo 05403-010, Brazil. angelo.kum@alumni.usp.br
Received: December 22, 2025 Revised: January 9, 2026 Accepted: January 26, 2026 Published online: February 16, 2026 Processing time: 55 Days and 3.3 Hours
Abstract
BACKGROUND
Endoscopic vacuum therapy (EVT) has emerged as a secure and efficient organ-preserving option for gastrointestinal perforations, leaks, and fistulas, with high closure rates and low mortality.
CASE SUMMARY
A 41-year-old woman with a history of Roux-en-Y gastric bypass and diaphragmatic repair with biological mesh developed a left-sided empyema due to a gastric pouch fistula complicated by pulmonary abscess and rib osteomyelitis. Multiple thoracic surgical interventions failed, leading to severe malnutrition and persistent pleural drainage. A complex gastro-pleuro-broncho-cutaneous fistula was diagnosed, and salvage EVT was performed using a staged approach, including percutaneous and transluminal EVT combined with bronchial endoscopic treatment. Complete fistula closure was achieved, with restoration of oral intake and significant weight gain at two-month follow-up.
CONCLUSION
This case highlights the successful use of a staged multimodal EVT strategy to achieve definitive closure of a complex gastro-pleuro-broncho-cutaneous fistula.
Core Tip: This case demonstrates the successful resolution of a complex gastro-pleuro-broncho-cutaneous fistula using a staged endoscopic vacuum therapy (EVT) approach. Following failed surgical interventions, a sequential strategy involving initial percutaneous EVT followed by transluminal EVT was implemented. Concurrently, the bronchial defect was managed with argon plasma coagulation and a custom collagen-cellulose plug. This multidisciplinary technique achieved complete fistula closure and nutritional restoration, suggesting that staged EVT is a promising, organ-preserving salvage option for refractory, multi-system fistulas.
