CLINICS 2011;67(2):195-197 An approach for treating aortoesophageal fistula Chen X et al. Figure 3A and B - CT angiography confirmed successful tamponade of the fistula. secondary esophageal reconstruction was previously a standard surgical approach for the treatment of esophageal fistulas. However, this procedure is time consuming and can cause significant surgical trauma. Thoracoscopy is a mini- mally invasive technique for managing mediastinal and thoracic diseases (8,9). Esophageal stents are universally applied to treat stenosis of the esophagus and esophageal perforation (10,11). We used thoracoscopy instead of med- iastinal debridement, irrigation and drainage. We implanted retrievable esophageal stents and placed a three-lumen gastrojejunal tube. Esophageal stents avoid saliva and/or exudates passing through the esophageal fistula into the mediastinum to prevent mediastinal infection. In this case, we chose a removable esophageal stent because the patient was a young man with benign esophageal disease. The three- lumen gastrojejunal tube ensured early postoperative intake of nutrients. After removal of the three-lumen gastrojejunal tube on postoperative day 7, the patient was provided with a liquid diet for nutritional support. This report represents the first case in which the minimally invasive approaches described were combined to successfully treat a patient with AEF. Based on our limited experiences, we suggest performing aortic endovas- cular repair by stent-graft to ultimately reduce the risk of aortic rupture, followed by thoracoscopy to treat mediast- inal infections and placement of a retrievable esophageal stent in patients with AEF who have slight inflammation or perforation of the esophageal region and surrounding tissues. The combined approach resulted in less trauma and a more rapid recovery compared to conventional thoracotomy. This minimally invasive approach may be a safe and feasible method for treating patients with AEF and has the potential for improved treatment options for AEFs. A larger sample size and long-term follow-up of patients with AEFs will be required to further evaluate the feasibility of this novel combined approach. ACKNOWLEDGMENTS We would like to thank Prof. Wenjian Wang and Xun Hou, PhD of the First Affiliated Hospital of Sun Yat-sen University for editing the manuscript. AUTHOR CONTRIBUTIONS Chen XD and Li JW inserted the endovascular stent, drafted the document, reviewed the literature, revised and critically edited the drafts and contributed equally to this work. Zhang YQ assisted in drafting the document and participated as a surgeon in the case. Ding HF, Huang SC, and Zhang Z participated as surgeons in the case. Chen J performed the thoracoscopic operation. Zhou Y inserted and removed the esophageal stent. REFERENCES 1. Verhoeven EL, Vourliotakis G. 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