Multidisciplinary management of bronchoesophageal fistula using adipose-derived stromal vascular fraction and platelet-rich plasma

Background and aims: Bronchoesophageal fistula (BEF) is a rare but life-threatening adverse event following surgery. Fistulas result in respiratory adverse events, often requiring surgical repair, which is a high-risk procedure. Therefore, minimally invasive alternatives are needed. We aimed to use adipose-derived stromal vascular fraction (SVF) to treat BEFs. Methods: We present 2 BEF cases after minimally invasive esophagectomy and gastric conduit reconstruction. During the procedure, SVF was isolated and platelet-rich plasma (PRP) obtained. In 1 case with a tracheaesophageal fistula, simultaneous bronchoscopy and endoscopy were performed to localize and treat the fistula; in the second case, only gastroscopy was performed to treat a fistula from the esophagus to the right upper lobe. During the procedures, the epithelialized fistula tract was cleared using brushing and argon plasma coagulation, followed by injection of SVF-PRP around the fistula. Closure was obtained using a through-the-scope suturing system. Results: The patients recovered well, and an esophagram 4 weeks postprocedure showed no more signs of a fistula. Currently, 7 and 4 months postprocedure, respectively, both patients are on a normal oral diet and with restored pulmonary function. Conclusions: These cases demonstrate that SVF-PRP injection combined with endoscopic closure may offer a promising minimally invasive alternative for BEF treatment.