Primarily endoscopic management of post surgical fistulas of the upper digestive tract is an effective management strategyy

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Aims Post surgical fistula of upper digestive tract (UDT) are related with significant morbidity and mortality. We aimed to evaluate the efficacy and safety of a primarily endoscopic approach to management of post surgical fistula of UDT. Methods We performed a multicentric and retrospective analysis with 114 consecutive patients with primarily endoscopic management of post surgical fistula between 03/2009-01/2022. Statistical analysis was performed with IBM-SPSS and pvalues<0.05 considered significant. Results The mean age was 55,49±16,38years and 64 (60,3%) were female. Obesity in 59 (52%) and cancer in 46 (41%) were the main indications for surgery. The median time between surgery and fistulas’ diagnosis was 7(4-12)days and average fistula size of 7,1±0,6mm. Endoscopic interventions included placement of a covered metallic stent in 92 (80,7%) patients (fully-covered n=43, partially covered n=34, both n=15), clips in 59 (51,7%) patients (OTS-clip n=38, TTS n=17, both n=4) and argon plasma in 17 (14,9%) patients. Early adverse events (<1week) occurred in 20(19,2%) and these included stent migration (n=10) and GI bleeding (n=5). Late adverse events occurred in 24 (21,0%) patients, namely stenosis (n=7), mucosal overgrowth (n=4) and prothesis frature (n=5). A death due to aortoesophageal fistula ocorred. Therapeutic success (definitive fistula closure) was documented in 85% (n=97) patients, requiring a median of 3 endoscopies and after a median of 8.0 (5-18,25) weeks. No predictive factors of fistula closure were detected. Conclusions The primarily endoscopic approach to management of UDT post surgical fistulas was possible inmore than three fourths of the patients with a good safety profile. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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