Endoscopy esophageal mucosal circumferential resection followed by bypass surgery to treat tracheoesophageal fistula

Objective

Tracheoesophageal fistula (TEF) is a severe complication often associated with advanced thoracic malignancies or chemoradiotherapy. This study introduces an innovative approach combining endoscopic submucosal dissection (ESD) and esophageal bypass surgery. This retrospective study aimed to evaluate the prognosis of patients with TEF in complete clinical remission after definitive chemoradiotherapy who underwent repair with such approach.

Methods

This is a retrospective analysis of 12 patients with TEF secondary to thoracic malignancies treated between June 2021 and June 2022. Patients underwent ESD for de-epithelialization of the esophageal lumen, followed by esophageal bypass surgery. Key outcomes included survival rates, fistula closure rates, postoperative clinical outcomes, and functional status improvement assessed by Karnofsky Performance Status scores.

Results

All patients had complete clinical remission of their primary malignancies before treatment. TEF closure was achieved in 10 patients (83.3%) within 28 to 72 days post-ESD. Median duration from ESD to bypass surgery was 39 days. Kaplan-Meier analysis revealed a 1-year survival rate of 65% and a 2-year survival rate of 60%. Postoperative morbidity included 1 anastomotic leak and 1 case of esophageal mucoceles, both successfully managed. Functional outcomes significantly improved, with 91.6% of patients achieving a Karnofsky Performance Status score >80 at 6 months.

Conclusions

The combination of ESD and esophageal bypass surgery represents a promising approach for TEF management, demonstrating high rates of fistula closure, enhanced functional outcomes, and overall survival. Future studies should aim to validate these findings in larger cohorts and explore the long-term sustainability of these outcomes.