Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic treatment of nonmalignant tracheoesophageal and bronchoesophageal fistula: results and prognostic factors for its success

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Nonmalignant esophago-respiratory fistulas (ERF) are frightening clinical situations, involving surgery with high morbi-mortality rate. We described the endoscopic management of benign ERF. The aim of the study was to describe outcomes of endoscopic treatment of nonmalignant ERF and to analyze factors associated with its success.

Methods

This is a retrospective study involving patients managed for benign ERF in our center between 2012 and 2016. The ERFs were classified into three groups of sizes: (I) punctiform, (II) medium, and (III) large. The primary aim was to document the endoscopic success (= fistula’s healing after 6 months). The secondary objectives were characteristics of endoscopic treatment, the functional success and death, and identifying factors associated with success and death.

Results

22 patients were included. The etiologies of ERF were surgery in 12 patients, esophageal dilatation in 3, invasive ventilation in 3, radiation therapy in 2, and tracheostomy in 2. Ninety-three procedures were performed (mean of number: 4.2 ± 4.5/patient). Twenty-one patients had stent placement, eight over-the-scope clips (OTSC), and seven a combined therapy. The endoscopic success rate was 45.5% (n = 10; 67% in punctiform, 50% in medium, and 14% in large ERF), and the functional success was 55% (n = 12). Serious adverse events occurred in 9 patients (40.9%). Six patients died (27%). The persistence of the orifice after 6 months of endoscopic treatment was associated with failure (OR 44; IC95: 3.38–573.4; p = 0.004 multivariate analysis). The orifice’s size was associated with mortality [71% of death if large fistulas (p = 0.001) univariate analysis].

Conclusion

Endoscopic treatment of ERF leads to 45.5% of successful endoscopic closure and 55.5% of functional success, depending on fistula’s orifice size. After 6 months without healing, the chances for success dramatically decrease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Shin JH, Song H-Y, Ko G-Y, Lim J-O, Yoon H-K, Sung K-B (2004) Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 232:252–259. https://doi.org/10.1148/radiol.2321030733

    Article  PubMed  Google Scholar 

  2. Spaander M, Baron T, Siersema P, Fuccio L, Schumacher B, Escorsell À, Garcia-Pagán J-C, Dumonceau J-M, Conio M, de Ceglie A, Skowronek J, Nordsmark M, Seufferlein T, Van Gossum A, Hassan C, Repici A, Bruno M (2016) Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 48:939–948. https://doi.org/10.1055/s-0042-114210

    Article  PubMed  Google Scholar 

  3. Flege JB (1967) Tracheoesophageal fistula caused by cuffed tracheostomy tube. Ann Surg 166:153–156

    Article  PubMed Central  PubMed  Google Scholar 

  4. Muniappan A, Wain JC, Wright CD, Donahue DM, Gaissert H, Lanuti M, Mathisen DJ (2013) Surgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg 95:1141–1146. https://doi.org/10.1016/j.athoracsur.2012.07.041

    Article  PubMed  Google Scholar 

  5. Bartels HE, Stein HJ, Siewert JR (1998) Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome. Br J Surg 85:403–406. https://doi.org/10.1046/j.1365-2168.1998.00579.x

    Article  CAS  PubMed  Google Scholar 

  6. Iannettoni MD, Whyte RI, Orringer MB (1995) Catastrophic complications of the cervical esophagogastric anastomosis. J Thorac Cardiovasc Surg 110:1493–1500. https://doi.org/10.1016/S0022-5223(95)70072-2

    Article  CAS  PubMed  Google Scholar 

  7. Gudovsky LM, Koroleva NS, Biryukov YB, Chernousov AF, Perelman MI (1993) Tracheoesophageal fistulas. Ann Thorac Surg 55:868–875

    Article  CAS  PubMed  Google Scholar 

  8. Baisi A, Bonavina L, Narne S, Peracchia A (1999) Benign tracheoesophageal fistula: results of surgical therapy. Dis Esophagus 12:209–211

    Article  CAS  PubMed  Google Scholar 

  9. Silon B, Siddiqui AA, Taylor LJ, Arastu S, Soomro A, Adler DG (2017) Endoscopic management of esophagorespiratory fistulas: a multicenter retrospective study of techniques and outcomes. Dig Dis Sci 62:424–431. https://doi.org/10.1007/s10620-016-4390-0

    Article  PubMed  Google Scholar 

  10. Macchiarini P, Verhoye JP, Chapelier A, Fadel E, Dartevelle P (2000) Evaluation and outcome of different surgical techniques for postintubation tracheoesophageal fistulas. J Thorac Cardiovasc Surg 119:268–276. https://doi.org/10.1016/S0022-5223(00)70182-6

    Article  CAS  PubMed  Google Scholar 

  11. Gruner M, Heissat S, Pitiot V, Suy P, Lachaux A, Ponchon T, Pioche M (2017) Successful endoscopic closure of a refractory button-battery tracheoesophageal fistula in a 3-year child using endoscopic submucosal dissection of the surrounding mucosa. Endoscopy 49:E212–E214. https://doi.org/10.1055/s-0043-113549

    Article  PubMed  Google Scholar 

  12. Bertrand G, Jacques J, Rivory J, Rostain F, Saurin J-C, Ponchon T, Pioche M (2017) Deep endoscopic submucosal dissection of a refractory tracheoesophageal fistula using clip-and-line traction: a successful closure. Endoscopy 49:1278–1280. https://doi.org/10.1055/s-0043-119348

    Article  PubMed  Google Scholar 

  13. Adler DG, Pleskow DK (2005) Closure of a benign tracheoesophageal fistula by using a coated, self-expanding plastic stent in a patient with a history of esophageal atresia. Gastrointest Endosc 61:765–768

    Article  PubMed  Google Scholar 

  14. Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Devière J (2011) Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc 73:890–899. https://doi.org/10.1016/j.gie.2010.12.019

    Article  PubMed  Google Scholar 

  15. Gonzalez J-M, Servajean C, Aider B, Gasmi M, D’Journo XB, Leone M, Grimaud JC, Barthet M (2016) Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series. Surg Endosc 30:4895–4903. https://doi.org/10.1007/s00464-016-4828-7

    Article  PubMed  Google Scholar 

  16. D’Journo X-B, Michelet P, Dahan L, Doddoli C, Seitz J-F, Giudicelli R, Fuentes PA, Thomas PA (2008) Indications and outcome of salvage surgery for oesophageal cancer☆. Eur J Cardio-Thoracic Surg 33:1117–1123. https://doi.org/10.1016/j.ejcts.2008.01.056

    Article  Google Scholar 

  17. Fiorica F, Di Bona D, Schepis F, Licata A, Shahied L, Venturi A, Falchi AM, Craxì A, Cammà C (2004) Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53:925–930

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS (2005) Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg 27:3–7. https://doi.org/10.1016/j.ejcts.2004.09.018

    Article  CAS  PubMed  Google Scholar 

  19. Schweigert M, Solymosi N, Dubecz A, Stadlhuber RJ, Muschweck H, Ofner D, Stein HJ (2013) Endoscopic stent insertion for anastomotic leakage following oesophagectomy. Ann R Coll Surg Engl 95:43–47. https://doi.org/10.1308/003588413X13511609956255

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Endoscopy Unit, North Universitary Hospital, Marseille, France

    Antoine Debourdeau, Jean-Michel Gonzalez, Alban Benezech & Marc Barthet

  2. Gastroenterology and Liver Transplantation Unit, CHU Montpellier, Univ Montpellier, Montpellier, France

    Antoine Debourdeau

  3. Pulmonary Endoscopy Unit, North Universitary Hospital, Marseille, France

    Hervé Dutau

  4. Service d’hépato-gastroentérologie A, Hôpital Saint-Éloi, CHU Montpellier, Montpellier Univ, 80 avenue Augustin Fliche, 34000, Montpellier, France

    Antoine Debourdeau

Authors
  1. Antoine Debourdeau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Michel Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hervé Dutau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alban Benezech
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc Barthet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antoine Debourdeau.

Ethics declarations

Disclosures

Dr Marc Barthet is consultant in endoscopy for Boston Scientifics. Drs Antoine Debourdeau, Jean-Michel Gonzalez, Hervé Dutau, and Alban Benezech have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Debourdeau, A., Gonzalez, JM., Dutau, H. et al. Endoscopic treatment of nonmalignant tracheoesophageal and bronchoesophageal fistula: results and prognostic factors for its success. Surg Endosc 33, 549–556 (2019). https://doi.org/10.1007/s00464-018-6330-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6330-x

Keywords

Search

Navigation