A retrospective study of endoscopic treatment of esophageal fistulas on the efficacy and safety

Abstract

Abstract Background There are currently no standard treatments for esophageal fistulas (EFs) and endoscopic therapy may be recommended with minimally invasive and lower mortality. This study aims to investigate the efficacy and safety of endoscopic treatment in treating EFs and the standardized evidence-based strategy for the management of EFs. Methods We retrospectively studied patients with EFs who underwent endoscopic treatment or best supportive care (BSC) for 12 years. The success rate, survival, and other clinical data were compared. Results A total of 52 patients were included in this study, including 16 stents, 7 through-the-scope-clips, 2 over-the-scope-clips, 1 endoscopic suturing, and 26 BSC. The clinical success rate was higher in endoscopic treatment compared with BSC treatment (76.9% vs 33.3%, P = 0.002). Endoscopic treatment leads to higher survival rates for patients with malignant EFs than BSC (125 days vs 62 days, hazard ratio = 0.35, P = 0.042). In contrast, those with benign EFs had a similar overall survival rate. Endoscopic treatment maintains hemoglobin levels and lower CRP in EF patients (P = 0.733, P = 0.019). In addition, endoscopic treatment better maintains ECOG and nrs2002 scores for patients with malignant EFs. (0.00 vs -0.50, 0.00 vs -0.50, P = 0.037, P = 0.021). Adverse events occurred in 8 (30.8%) patients treated with esophageal stents; two (7.7%) were significant complications. Conclusion Endoscopic treatment is a safe option for patients with EFs. For benign EFs, endoscopic therapy can be an option for inoperable patients or as a bridge before surgery. For malignant EFs, self-expendable metallic stents (SEMS) can be the first line of treatment.