Outcomes of esophageal diversion and long-term prognosis: A single-institution experience

Esophageal diversion of the esophagus is a last resort but effective procedure to control esophageal crises. Existing reports on this procedure are sporadic, and the prognosis is difficult to predict.

We performed a single-institution, retrospective study of patients who underwent esophageal diversion with cervical esophagostomy from 2014 to 2023. Esophageal diversion was performed for primary and secondary esophageal pathologies, including referrals from outside facilities. Primary outcomes are survival and reconstruction rate.

During the study period, a total of 170 patients underwent esophageal diversion with cervical esophagostomy for various pathologies: 26 conduit ischemia after esophagectomy, 42 perforations (11 malignant), 24 tracheoesophageal fistula, 30 esophagectomies with delayed reconstruction, 24 conduit revisions, and 24 other benign pathologies. Survival to discharge was 84.1%. Reconstruction was performed in 97 patients (57.1%) after a median of 6.3 months. The primary reason for nonreconstruction was poor health or death (60 patients [82.2%]), followed by malignancy progression (9 patients [12.3%]). Gastric conduit was used for substernal reconstruction in 81 patients (83.5%), whereas 15 colon interpositions and 1 Roux-en-Y jejunal reconstruction were also utilized (16.5%). Despite high leak rates, 42.0% with gastric conduits, the majority of them were managed conservatively, and the survival to discharge after reconstruction was 94.8%. Median survival after reconstruction was 69.9 months.

Esophageal diversion ensures safe control of the crisis, even in the face of complex esophageal pathologies. Despite the high anastomotic leak rate following reconstruction, long-term survival was favorable once patients recovered from the initial episode and underwent reconstruction.