LAUSR

A 72-year-old woman was treated with endotracheal intubation and mechanical ventilation for shock caused by herbicide poisoning. After extubation she presented with cough. Tracheoscopy and gastroscopy both showed a perforation measuring about 1 cm (▶Fig. 1 a, b). The tracheoesophageal fistula (TEF) was treated with a purse-string suture via a gastroscope (GIF-Q260J; Olympus, Tokyo, Japan) (▶Video 1). In brief, an endoloop (Leo Medical, Changzhou, China) was inserted by forceps and anchored onto the full thickness of the edge of the fistula, including both the esophageal wall and the tracheal wall, with a titanium clip (Micro-Tech, Nanjing, China) (▶Fig. 1 c). After adjustment of the angle, three additional repositionable clips were used to secure the endoloop on different sides of fistula. The removable hook was then inserted and connected with the ring on the tail of the endoloop, which was tightened to pull the edges of the fistula together. The hook was then removed and the TEF was closed (▶Fig. 1d). To further strengthen the closure of the fistula, an endoclip was added to clamp the still visible small hole (▶Fig. 1 e). The patient was put on nasal feeding after operation and her cough took a turn for the better. One month later, gastroscopy showed that the endoclips and endoloop had E-Videos