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 adverse event 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 reintervention and particularly in cases of major tissue defects of >10 mm. Methods: Fifty-seven patients with postoperative large esophageal fistulas who were not considered for surgical reintervention were retrospectively analyzed after undergoing treatment with different endoscopic techniques in a single tertiary center. The primary endpoint was to evaluate the technical and clinical efficacy of endoscopic treatments of those fistulas. The secondary endpoint was to evaluate the endoscopic treatment-related adverse events. Results: In 94.7% of patients (n = 54), the intervention was effectively carried out from a technical point of view. In 77.2% of patients (n = 44), treatment led to successful complete closure of the fistula. If we consider the 54 patients in whom technical success was reached, in 75.9% of them (n = 41), clinical success with complete closure of the fistula was achieved. Minor adverse events related to the procedure occurred in 26.32% of patients (n = 15) and major adverse events 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 postoperative large esophageal fistulas in patients who were not considered fit for surgical treatment, including major defects of >10 mm. It allows patients with a high risk of rapid deterioration to safely recover from their condition, avoiding severe and fatal adverse events without having to resort to debilitating surgical treatment.