Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes
- 23 December 2016
- journal article
- research article
- Published by Springer Science and Business Media LLC in Digestive Diseases and Sciences
- Vol. 62 (2), 424-431
- https://doi.org/10.1007/s10620-016-4390-0
Abstract
Esophagorespiratory fistulas (ERF) are a devastating complication of benign and malignant etiologies. ERF are associated with high mortality, short survival, and poor quality of life. We performed a multicenter analysis of patients with ERF undergoing endoscopic treatment. Multicentre retrospective study. We analyzed 25 patients undergoing 35 procedures over an 8-year period. Our data showed high technical success rates (97.1% of procedures) and with good, but not ideal, clinical success rates (60% of procedures, 80% of patients), which were defined as fistula closure confirmed by radiographic or repeat endoscopic evaluation and/or a lack of recurrent episodes of clinical aspiration to focus on durable ERF closure as opposed to only initial success. Proximal ERF were the most difficult to manage with the lowest overall clinical success rates, highest rates of recurrent aspiration despite endoscopic therapy, highest adverse events, and shortest survival times. Adverse events occurred in 40.0% of our patients and were all minor. Treatment allowed for diet advancement in 75% of patients. This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.Keywords
This publication has 18 references indexed in Scilit:
- Interventional Management of Esophagorespiratory FistulaKorean Journal of Radiology, 2010
- Palliative Treatment of Malignant Esophagopulmonary Fistulas With Covered Expandable Metallic StentsAmerican Journal of Roentgenology, 2009
- Comparative study of different treatments for malignant tracheoesophageal/bronchoesophageal fistulaeDiseases of the Esophagus, 2009
- Characteristics of Esophagorespiratory Fistulas Resulting from Esophageal Cancers: A Single‐Center Study on 243 Cases in a 20‐Year PeriodWorld Journal of Surgery, 2009
- Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year periodEuropean Journal of Cardio-Thoracic Surgery, 2008
- Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulasGastrointestinal Endoscopy, 2007
- Closure of a benign tracheoesophageal fistula by using a coated, self-expanding plastic stent in a patient with a history of esophageal atresiaGastrointestinal Endoscopy, 2005
- Palliative Treatment of Malignant Esophagorespiratory Fistulas With Gianturco-Z Stents: A Prospective Clinical Trial and Review of the Literature on Covered Metal StentsThe American Journal of Gastroenterology, 1998
- Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistulaGastrointestinal Endoscopy, 1996
- Treatment of esophagorespiratory fistulas with silicone-coated self-expanding metal stentsGastrointestinal Endoscopy, 1995