Endoscopic treatment of nonoperable large postsurgical esophageal fistulas: retrospective analysis of a single tertiary center cohort

Background and aims: Anastomotic fistulas are a frequent and dreaded complication of esophagectomy.Endoscopic therapy using different techniques is now a well-established first line treatment option.The aim of our study was to evaluate the efficacy of such endoscopic treatments in patients not fit for surgical re-intervention and particularly in case of major tissue defects of more than 10 millimeters.Methods: 57 patients with post-operative large esophageal fistulas who were not considered for surgical re-intervention were retrospectively analyzed after being treated with different endoscopic techniques in a single tertiary center.The primary endpoint was to evaluate technical and clinical efficacy of endoscopic treatments of those fistulas.The secondary endpoint was to evaluate the endoscopic treatments-related complications.Results: In 94.7% (n=54) of patients, the intervention was effectively carried out from a technical point of view.In 77.2% (n=44) of patients, treatment led to successful complete closure of the fistula.If we consider the 54 patients in which technical success was reached, in 75.9% (n=41) of them, clinical success with complete closure of the fistula was achieved.Minor complications related to the procedure occurred in 26.32% (n=15) of patients and major complications in 8.8% (n=5).The mortality rate related to the procedure was 3.5% (n=2).Conclusions: Endoscopic treatment is a technically achievable, highly effective way of treating post-operative large esophageal fistulas in patients who were not considered fit for surgical treatment, including major defects of more than 10 millimeters.It allows patients with high risk of rapid deterioration to safely recover from their condition, avoiding severe and fatal complications without having to resort to debilitating surgical treatment.