A non-invasive protocol for the treatment of gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy

Abstract

Background: We aimed to study the safety and efficacy of three tubes with or without covered esophageal stent placement for the management of gastro-mediastinal or gastro-pleural fistula. Methods: We retrospectively assessed the clinical data of 31 consecutive patients with gastro-mediastinal or gastro-pleural fistula treated by using a non-invasive protocol. Patients received three tubes (jejunal feeding tube, gastrointestinal drainage tube and abscess drainage tube) with or without esophageal covered stent placement. All patients received continue abscess drainage and nutritional support after procedure. The tubes and/or esophageal covered stents were removed after fistula healing. Results: All patients received three tubes placement and 11 patients with lumenal narrowing received esophageal covered stent placement. Technically success was found in all patients, with no perioperative death, esophageal rupture or massive hemorrhage. Abscess cavity disappeared in 22 patients, with a clinical success rate of 71.0%. All patients received esophageal stent placement were cured and stents were removed, for the median duration of 1.6 months (IQR 1.4, 3.7). Three patients showed clinical improved, with markedly decreased abscess cavity and markedly shrunk fistula. The median survival was 30.8 months. The 1-, 3-, 5-year survival rates were 71.1%, 46.1% and 39.5%, respectively. Conclusions: A non-invasive protocol of three tubes with or without covered esophageal stent placement is safe and effective for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy.