Endoscopic management of tracheoesophageal fistulas: a narrative review

The formation of pathologic communication between respiratory and digestive tracts is a morbid condition which possesses management challenges regardless of its etiology. Severity of the symptoms related to contamination of the respiratory tract with oral and gastric secretions calls for timely seal and closure translating into improved mortality. The aim of this article is to review the latest data in regards of tracheoesophageal fistulas (TEFs) and the endoscopic methods of their management.

A literature review was conducted in the National Institute of Health's PubMed database in July 2024. Only studies published in English with abstracts available were included. Over 2,700 articles were found. The first 800 abstracts for "tracheoesophageal fistula" were reviewed and used to guide more detailed searches. Fifty-seven publications were considered relevant, and their full text studied to collate information for this review.

We summarized the endoscopic approaches to management of both benign and malignancy associated TEFs as reported in the literature to this date. Despite several new non-operative approaches, esophageal stenting with or without airway stenting remains the mainstem of the endoscopic treatment of the fistulas. Self-expanding metallic stents are the mainstay of this approach. Esophageal stenting in particular has been associated with improved fistula closure and quality of life, as well as possible improvement in mortality for malignancy associated fistulas. More novel methods such as suturing or clips, occluding devices, and tissue adhesives also show promise. The quality control after the initial endoscopic management sets the future steps. Early multidisciplinary discussion among aerodigestive specialists including endoscopists and surgeons with involvement of palliative care team is strongly recommended.

The ever-evolving landscape of endoscopic therapies offers minimally invasive approach to TEFs especially for patients with prohibitive conditions to surgery or for patients needing a temporizing measure until the definitive surgical treatment is possible.