A noninvasive treatment for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy

Abstract

Our objective was to assess the safety and efficacy of 3 tubes with or without covered esophageal stent placement for the management of gastro-mediastinal or gastro-pleural fistula. We retrospectively assessed the clinical data of 31 consecutive patients with gastro-mediastinal or gastro-pleural fistula treated by using a noninvasive treatment from February 2013 to July 2022. Patients received 3 tubes (jejunal feeding tube, gastrointestinal drainage tube and abscess drainage tube) with or without esophageal-covered stent placement. All patients received continue abscess drainage and nutritional support after procedure. The tubes and/or esophageal-covered stents were removed after fistula healing. All patients received 3 tubes placement and 11 patients with luminal narrowing received esophageal covered stent placement. Technically success was found in all patients, with no procedure-related death, esophageal rupture or massive hemorrhage. Abscess cavity disappeared in 22 patients, with a clinical success rate of 71.0%. All patients received esophageal stent placement were cured and stents were removed, for a median duration of 1.6 months (interquartile ranges [IQR] 1.4, 3.7). Three patients showed clinical improved, with markedly decreased abscess cavity and markedly shrunk fistula. The median survival was 30.8 months. The 1-, 3-, 5-year survival rates were 71.1%, 46.1% and 39.5%, respectively. A noninvasive treatment of 3 tubes with or without covered esophageal stent placement is safe and effective for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy.