Multidisciplinary collaboration between different services makes it possible to perform a complex endoscopic procedure at the HUB for the first time

Multidisciplinary collaboration was essential for the procedure, which was triggered when a tracheoesophageal fistula was detected in a person initially admitted for oesophageal surgery. A bronchoscopy revealed that the fistula had been caused by the displacement of two oesophageal prostheses into the trachea, causing respiratory failure that led the patient to the ICU.

It was then that a joint procedure between thoracic surgery, general surgery, anaesthesiologists, gastroenterologist and interventional pulmonologists, together with nursing, was proposed to try to remove the prostheses from the trachea. Although initially the plan was to remove the prostheses via the oesophagus, given that the displacement had led them to become lodged deep inside the trachea, it was finally decided to perform the extraction through the trachea itself, with a rigid bronchoscopy, instead of via the digestive tract.

With the patient intubated with rigid bronchoscopy to exclude the fistula, a tracheostomy was performed by thoracic surgeons to protect the airway. Subsequently, the two oesophageal prostheses were removed via the airway by the interventional pulmonologists, and the oesophagus was dilated by the interventional gastroenterologists in order to place a nasogastric feeding tube. Finally, the intubation tube through the tracheostomy was replaced by a special cannula, also guided by rigid bronchoscopy.

The patient had no complications from the procedure. Once she leaves the ICU, the general surgeons are scheduled to perform the necessary interventions for the reconstruction of the oesophagus.