Endoscopic pedicle flap grafting in the treatment of esophageal fistulas: A case report

Figure 1 Results of examinations and treatment. A: Computed tomography scan (rightward arrow: Fistula; downward arrow: Esophageal lumen); B: Esophagram revealed the presence of esophageal fistula (arrow) around the 9^th vertebra level; C: Endoscopic examination confirmed the presence of two fistulas, which are 0.3 cm (left arrow) and 0.5 cm (middle arrow) in diameter and the esophageal lumen (right arrow); D and E: Submucosal injection was followed by (E) endoscopic submucosal dissection; F: The mucosal flap (lower arrow) with the caudal edge reserved as the pedicle (upper arrow) was made ready after endoscopic submucosal dissection; G and H: Ablation of the surrounding mucosa before (H) covering the fistulas with the flap; I: Several titanium clips were used for fixation; J: Ulcer area left after endoscopic submucosal dissection; K: Percutaneous gastrostomy; L: Forty-five days after the endoscopic surgery, the larger fistula (arrow) reduced from 0.5 cm to 0.2 cm and the smaller one was closed.