Endoscopic treatment of nonmalignant tracheoesophageal and bronchoesophageal fistula: results and prognostic factors for its success

Abstract

Endoscopic treatment of ERF leads to 45.5% of successful endoscopic closure and 55.5% of functional success, depending on fistula's orifice size. After 6 months without healing, the chances for success dramatically decrease.

Successful Closure of a Benign Refractory Tracheoesophageal Fistula Using an Over-the-Scope Clip after Failed Esophageal Stent Placement and Surgical Management

“…In terms of endoscopic management of benign ERFs, a retrospective study of 22 patients was conducted to evaluate clinical outcomes and predictive factors associated with clinical success. 5 The causes of ERFs in this series were surgical anastomotic fistulas, post-esophageal dilation, invasive ventilation, radiation therapy, and tracheostomy. The endoscopic method was selected based on the characteristics of the fistulas.…”

“…8 Recently, retrospective studies focusing on esophagorespiratory fistulas (ERFs) evaluated the factors influencing clinical outcomes after endoscopic treatment. 4,5 Silon et al 4 recruited 25 patients undergoing 35 procedures, and 56% of the patients had malignant fistulas. The treatment modalities included placement of an esophageal fully covered-self-expandable-metallic stent (FCSEMS), combined esophageal stent and bronchial stent, combined esophageal stent and OTSC, and combined esophageal stents, OTSC, and additional methods such as TTS clip, endoscopic suture, and APC.…”

“…Esophageal stent placement has been the most commonly used endoscopic technique for TEF closure. 4,5 The use of OTSCs has gained popularity in recent years; OTSCs can be used for the closure of entero-enteric fistulas and fistulas between the gastrointestinal tract and other organs such as the bronchus, skin, and urinary bladder. 2 Nonetheless, fistula closure using OTSCs in benign refractory TEFs after failed esophageal stent placement and surgical management have not been reported.…”

Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study

“…Several endoscopic therapies for closure of esophageal fistulas have been reported [1,[3][4][5][6][7]. Although endoscopic stenting can close esophageal fistulas in some cases, high recurrence and many adverse events were reported, such as migration, and severe pain; especially in cases of aorto-esophageal fistulas, the stenting can result in death [1,3,4]. An over-thescope-clipping (OTSC; Ovesco Endoscopy AG, Tubingen, Germany) system to close fistulas was also described [4,5,8].…”

“…Although endoscopic stenting can close esophageal fistulas in some cases, high recurrence and many adverse events were reported, such as migration, and severe pain; especially in cases of aorto-esophageal fistulas, the stenting can result in death [1,3,4]. An over-thescope-clipping (OTSC; Ovesco Endoscopy AG, Tubingen, Germany) system to close fistulas was also described [4,5,8]. However, fistulas sometimes have severe fibrosis, which is the most important predictor of OTSC failure and recurrence.…”