The Impact of Endoscopic Closure Treatment on Outcomes in Patients with Esophageal Cancer-Associated Fistula: A...

Esophageal cancer-associated fistula is strongly linked to elevated mortality. This study aims to investigate the impact of endoscopic closure on outcomes in patients with esophageal cancer-related fistula.

We retrospectively analyzed the clinical data of patients with esophageal cancer-related fistula. These patients were categorized into endoscopic closure group and conservative treatment group. The Clinical Pulmonary Infection Score (CPIS) gap, duration of hospitalization, ICU admission rates, in-hospital mortality rates, and hospitalization costs were compared between endoscopic group and conservative group. Additionally, factors associated with post-fistula survival and healing were assessed.

Univariate and multivariate COX regression analyses revealed that endoscopic closure could significantly improve short-term pulmonary infections based on CPIS gap (3 vs. 2; p = 0.004) but did not influence survival or fistula healing outcomes, and the hospitalization costs were elevated (USD 6,653 vs. USD 3,350; p = 0.005). Subgroup analysis focusing on esophagotracheal fistulas was also consistent with these results. Protective factors associated with improved survival prognosis included higher albumin levels (HR = 0.928, 95% CI: 0.875-0.984, p = 0.012), absence of bloodstream infections (positive blood culture [HR = 23.055, 95% CI: 5.193-102.357, p < 0.001]), non-T4 stage (T4 stage [HR = 1.792, 95% CI: 1.052-3.052, p = 0.032]), and no distant metastasis (distant metastasis [HR = 2.122, 95% CI: 1.127-3.996, p = 0.020]). Cervical esophageal fistula (upper [HR = 0.154, 95% CI: 0.041-0.570, p = 0.005]; middle [HR = 0.128, 95% CI: 0.027-0.609, p = 0.010]; lower [HR = 0.218, 95% CI: 0.052-0.902, p = 0.036]) was significantly associated with improved fistula healing outcomes, while a history of radiotherapy (HR = 0.265, 95% CI: 0.089-0.788, p = 0.017) was a risk factor for esophageal fistula healing.

Our study indicates that multiple factors are significantly associated with the prognosis of patients with esophageal fistula. Endoscopic closure treatment effectively manages short-term infections, but it associates with higher hospitalization costs and does not significantly enhance long-term healing or survival prognosis.