We present three patients with serious gastro-esophageal complications which were treated with
Tissucol. The first patient developed a rare postoperative oesophago-pleural
fistula. The second suffered a traumatic
esophageal perforation (possibly iatrogenic) that was discovered at the end of the removal procedure of an alimentary bolus impacted in the distal esophagus. Attempts to close the high output oesophago-pleural
fistula with standard treatment were unsuccessful. It was closed with
Tissucol at the third attempt, in conjunction with oesophago-jejunal
stenosis by means of endoscopic dilatation. In the second patient, early
Tissucol application after detection of
pneumomediastinum was an effective complementary treatment to the conservative approach and rapidly closed the perforation. The third patient developed a low debit postoperative gastro-
cutaneous fistula that did not resolve with
conservative treatment. It was closed with only one session of
Tissucol sealing. We consider that the endoscopic application of
fibrin glue should become the first step in the
conservative treatment of small
esophageal perforations or postoperative esophageal pleural fistulae, especially in cases of high output fistulae. The success of this technique depends on the localization and selective catheterization of the
fistula and on brushing the fistular opening. Total resolution of any distal
stenosis is necessary to prevent reopening of the
fistula.