Broncho-digestive fistulas are rare but serious post-surgical complications, and their management is particularly challenging in long or oblique tracts where the fistulous channel does not align parallel to luminal surfaces. Conventional endoscopic options—including clipping, stenting, or sealant injection—often fail because of fibrosis, poor tissue apposition, and high mechanical tension.We report the case of an 80-year-old woman with a complex surgical history, presenting with chronic cough and weight loss. After a Nissen fundoplication in 1993 complicated by pleural empyema, vagotomy, and severe gastroparesis, she underwent multiple pyloric dilations for gastric outlet obstruction. In 2003, a first gastro-bronchial fistula developed, likely secondary to chronic stasis, and several endoscopic treatments (fibrin glue, coagulation, bulking agents, and a bronchial plug) achieved only transient benefit. A subtotal gastrectomy with gastrojejunal reconstruction eventually progressed to total gastrectomy with left lung resection and Roux-en-Y esophagojejunal reconstruction in 2015.In 2019, she developed a new jejuno-bronchial fistula between the alimentary limb and the left bronchial tree. Multiple endoscopic approaches from 2019 to 2025—including TTS clips, APC, OTSC for candy-cane syndrome, ESD-flap with OTSC, vacuum-assisted stenting, and endoscopic suturing—resulted only in temporary improvement. Given the chronicity, fibrosis, and oblique trajectory of the tract, conventional endoscopic repair was considered unlikely to succeed, and no standardized strategy for definitive closure currently exists. Recently, systematic cough and inability to tolerate oral food recurred with exacerbation compromising quality of life and prognosis, letting to propose a novel modality of fistula closure to the patient.

A combined digestive–bronchial endoscopic approach was developed for definitive closure of this complex jejuno-bronchial fistula.

The procedure was performed under general anesthesia and fluoroscopic control. Simultaneous access through the jejunal and bronchial routes enabled full visualization using contrast opacification, of the fistulous path. Because the rigid bronchoscope could not reach the fistulous origin, a guidewire was advanced from the jejunal side into the left main bronchus and retrieved bronchoscopically.

Using a rendez-vous technique (bronchoscopic-jejunoscopic), after gentle abrasion of the fistula tract, an 8 Fr bronchial introducer was advanced through the fistula, and a self-expanding nitinol occlusion device (12 × 9 mm) was deployed, with the distal disc expanded into the jejunal lumen and the proximal portion anchored along the long, oblique tract.

A 50:50 mixture of cyanoacrylate glue (Glubran) and Lipiodol was then injected under fluoroscopic control into the expanded device, achieving homogeneous opacification and complete occlusion without extravasation.

The procedure was completed safely without complications. Immediate fluoroscopic and endoscopic assessment confirmed stable device positioning and complete tract sealing. A nasojejunal feeding tube was placed, and the patient resumed oral intake after 24 hours.At follow-up, she reported marked improvement of cough, with no symptoms during solid intake and only mild, qualitatively different cough with liquids. Early satiety persisted, but her nutritional status improved, and the nasojejunal tube was maintained per nutritional recommendations.

This dual-access endoscopic strategy demonstrates that self-expanding nitinol occlusion devices can be adapted to long, fibrotic, non-parallel fistulous tracts traditionally considered unsuitable for endoscopic repair.Although desscribed for tracheo-esophageal short fistula closure with parallel expanded discs, the use of self-expandable nitinol occlusion devices in long fistula tracts has not been reported.The combination of mechanical occlusion and cyanoacrylate sealing provides a reliable, minimally invasive solution for refractory broncho-digestive fistulas.This approach underscores the importance of multidisciplinary collaboration among interventional endoscopy, interventional radiology, and pulmonology in managing complex post-surgical fistulas.