How to preserve the native or reconstructed esophagus after perforations or postoperative leaks: A multidisciplinary 15-year experience

Table 1 Clinical characteristics and outcomes of the patients successfully managed by endoscopic/hybrid treatments

Characteristics	Population, n = 56 patients	Esophageal perforations, n = 12 patients	Anastomotic leaks, n = 44 patients
Male sex	42 (75.0)	11 (91.7)	31 (70.5)
Age in years	56.45 ± 12.70	58.13 ± 12.03	57.05 ± 13.09
Cardiovascular disease	12 (21.4)	2 (16.7)	10 (22.7)
DM	13 (23.2)	5 (41.7)	8 (18.2)
BMI	23.91 ± 5.37	25.23 ± 2.98	20.89 ± 10.45
Localization: Cervical	18 (32.2)	2 (16.6)	16 (36.4)
Middle esophagus	15 (26.8)	6 (50.0)	9 (20.5)
Distal esophagus	19 (33.9)	2 (16.7)	19 (43.1)
Cardias	4 (7.1)	2 (16.7)	0
Cause: Spontaneous	10 (17.9)	10 (83.3)	/
Iatrogenic	2 (3.6)	2 (16.7)	/
Post-surgical	44 (78.5)	/	44 (100.0)
Single/multiple orifice of the fistula	53 (94.6)/3 (5.4)	12 (100)	41 (93.2)/3 (6.8)
Size in mm	13 (5-30)	15 (6-24)	10 (4-30)
Mediastinal/pleural fluid collection	46 (82.1)	7 (58.3)	39 (88.6)
Side of pleural collection (right)	41 (73.2)	5 (41.7)	36 (81.8)
Chest tube	28 (50.0)	3 (25.0)	25 (56.8)
Surgical toilette pleural/mediastinal cavity	13 (23.2)	5 (41.7)	8 (18.2)
Time between acute event and treatment in days	4.5 (2-10)	8.5 (1.75-28.50)	4 (2-8.5)
First treatment
Endoscopic suture	5 (8.9)	1 (8.3)	4 (9.1)
Surgical suture + drainage	3 (5.4)	1 (8.3)	2 (4.5)
SEMS	8 (14.3)	3 (25.0)	5 (11.4)
EVAC	10 (17.9)	2 (16.7)	8 (18.2)
EDPC	2 (3.6)	2 (16.7)	0
tSVFem	4 (7.1)	1 (8.3)	3 (6.8)
Lateral esophagostomy (esophageal fistula)	3 (5.4)	1 (8.3)	2 (4.5)
Gauze packing of cervicotomy	11 (19.6)	1 (8.4)	10 (22.7)
Time between treatments in days	28 (10-61)	26 (8-51)	32 (7-57)
Second treatment
Endoscopic suture	0	0	0
Surgical suture + drainage	1 (1.8)	0	1 (2.3)
SEMS	7 (12.5)	0	7 (15.9)
EVAC	2 (3.6)	0	2 (4.5)
EDPC	0	0	0
tSVFem	5 (8.9)	2 (16.6)	3 (6.8)
Lateral esophagostomy (esophageal fistula)	7 (12.5)	3 (25.0)	4 (9.1)
Gauze packing of cervicotomy	1 (1.8)	0	1 (2.3)
Four-side hole nasogastric tube + intermitted suction	0	0	0
Fistula size after second treatment in mm	7.04 ± 4.29	4.26 ± 6.45	7.20 ± 4.36
Third treatment
tSVFem	5 (8.9)	0	5 (11.4)
Time to resolution in days	36 (15-71)	40 (11-150)	35 (15-71)

Data are n (%), mean ± standard deviation, or mean (interquartile range). BMI: Body mass index; DM: Diabetes mellitus; EDPC: Endoscopic double-pigtail catheter; EVAC: Endoscopic vacuum-assisted closure therapy; IQR: Interquartile range; SD Standard deviation; SEMS: Self-expanding-metal stent; tSVFem: Emulsified autologous stromal vascular fraction.

Table 2 Type of first treatment adopted and corresponding mean diameter of the esophageal fistula

Type of first treatment adopted	Fistula diameter in mm
Endoscopic suture	13.00 ± 9.90
Surgical suture + drainage	12.00 ± 1.53
SEMS	22.00 ± 6.21
EVAC	25.78 ± 20.16
EDPC	2.50 ± 0.59
tSVFem	8.21 ± 4.24
Lateral esophagostomy (esophageal fistula)	32.50 ± 24.74
Cervicotomy + gauze packing	15.00 ± 2.60
Four-side hole nasogastric tube + intermitted suction	3.53 ± 4.56

Data are mean ± standard deviation. EDPC: Endoscopic double-pigtail catheter; EVAC: Endoscopic vacuum-assisted closure therapy; SEMS: Self-expanding-metal stent; tSVFem: Emulsified autologous stromal vascular fraction.