Endoscopic treatment of iatrogenic perforation at the upper oesophageal sphincter after removal of an Ultraflex stent

Text A 65-year old female underwent a circumferential endoscopic mucosal dissection (ESD) of a squamous cell carcinoma in the middle third of the oesophagus. One day after the ESD she presented a perforation. A partially covered stent was placed. One month later, the stent was removed and the initial perforation was closed. However, one day later she developed again subcutaneous emphysema. Endoscopy confirmed the presence of a 5 mm wide fistula at 2 cm below the upper oesophageal sphincter. The fistula was fully closed using a 9 mm over-the-scope clip. The patient recovered well and follow-up endoscopy confirmed complete healing of the ESD site without tumor recurrence and complete fistula closure.