Endoscopy 2018; 50(04): S13
DOI: 10.1055/s-0038-1637063
ESGE Days 2018 oral presentations
20.04.2018 – Best care session 1
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC TREATMENT OF BENIGN ESOPHAGO-BRONCHIL FISTULAS. RESULTS OF A RETROSPECTIVE STUDY IN A LARGE VOLUME CENTER

JM Gonzalez
1   Hôpital Nord, AP-HM, Aix Marseille Univ., Gastroenterology, Marseille, France
,
A Debourdeau
2   Aix-Marseille Univ, Hôpital Nord, AP-HM, Gastroenterology, Marseille, France
,
A Benezech
2   Aix-Marseille Univ, Hôpital Nord, AP-HM, Gastroenterology, Marseille, France
,
M Barthet
2   Aix-Marseille Univ, Hôpital Nord, AP-HM, Gastroenterology, Marseille, France
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Nonmalignant esophago-respiratory fistulas (ERF) are a rare but frightening clinical situations, usually involving morbid surgery. The aim was to describe and assess the endoscopic management of benign ERF.

Methods:

Retrospective study involving patients manage for benign ERF between 2012 and December 2016. The ERFs were classified into three size groups: punctiform (orifice no larger than a straight catheter), medium and large (visibility of bronchial tree). The primary endpoint was the clinical success (= closure of the fistula confirmed by endoscopy and persisting > 6 months). The secondary endpoints were the characteristics of endoscopies, the functional success, and the factors associated with success and death.

Results:

22 patients were included. The etiologies of ERF were esophageal surgery in 12 patients (54,5%), esophageal dilatation in 3 (13,6%), invasive ventilation in 3 (13,6%), radiation therapy in 2 (9,1%) and tracheostomy in 2 (9,1%). Ninety-three procedures were performed with a mean of number of 4,2 ± 4,5 per patient. Twenty-one patients (95%) had esophageal stents placement, eight patients (36%) over the scope clips (OTSC) and seven had both. The clinical success rate was 45,5% (n = 10), and 55% of the patients had a functional success (n = 12). Serious adverse events occurred in 9 patients (40,9%) such as gastrointestinal bleeding (4 patients, 18,2%), or stent migration (4 patients, 18,2%). Clinical success was 67% for punctiform ERF (p = 0,193), 50% for medium ERF (p = 1) and 14% for large ERF (p = 0,17). The factor associated with failure was the persistence of the fistula after 6 months (OR = 44; IC95: 3,38 – 573,4; p = 0,004 multivariate analysis). The orifice's size was associated with mortality, with 71% of death among large fistulas (p = 0,001 univariate analysis).

Conclusions:

Endoscopic treatment of ERF leads to 45.5% of clinical success and 55.5% of functional success. However, the absence of resolution after 6 months of endoscopic treatment dramatically decreases the chance for ERF healing.