Bryan Silon1, Ali A Siddiqui2, Linda Jo Taylor1, Sanaa Arastu2, Ammara Soomro2, Douglas G Adler3. 1. Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA. 2. Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA. 3. Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA. douglas.adler@hsc.utah.edu.
Abstract
BACKGROUND AND AIMS: 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. METHODS: Multicentre retrospective study. RESULTS: 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. CONCLUSION: 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.
BACKGROUND AND AIMS: 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. METHODS: Multicentre retrospective study. RESULTS: 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. CONCLUSION: 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.
Entities:
Keywords:
Clip; Esophagorespiratory; Fistula; Stent; Suture; TE fistula; Tracheoesophageal
Authors: R A Kozarek; S Raltz; W R Brugge; R H Schapiro; I Waxman; H W Boyce; J Baillie; M S Branch; P D Stevens; C J Lightdale; G A Lehman; S Benjamin; D E Fleischer; A Axelrad; P Kortan; N Marcon; S Branch; P Stevens Journal: Gastrointest Endosc Date: 1996-11 Impact factor: 9.427
Authors: William A Ross; Firas Alkassab; Patrick M Lynch; Gregory D Ayers; Jaffer Ajani; Jeffrey H Lee; Mike Bismar Journal: Gastrointest Endosc Date: 2007-01 Impact factor: 9.427