Staged multimodal endoscopic vacuum therapy for a complex gastro-pleuro-broncho-cutaneous fistula: A case report

BACKGROUND: Endoscopic vacuum therapy (EVT) has emerged as a secure and efficient organ-preserving option for gastrointestinal perforations, leaks, and fistulas, with high closure rates and low mortality. CASE SUMMARY: A 41-year-old woman with a history of Roux-en-Y gastric bypass and diaphragmatic repair with biological mesh developed a left-sided empyema due to a gastric pouch fistula complicated by pulmonary abscess and rib osteomyelitis. Multiple thoracic surgical interventions failed, leading to severe malnutrition and persistent pleural drainage. A complex gastro-pleuro-broncho-cutaneous fistula was diagnosed, and salvage EVT was performed using a staged approach, including percutaneous and transluminal EVT combined with bronchial endoscopic treatment. Complete fistula closure was achieved, with restoration of oral intake and significant weight gain at two-month follow-up. CONCLUSION: This case highlights the successful use of a staged multimodal EVT strategy to achieve definitive closure of a complex gastro-pleuro-broncho-cutaneous fistula.