title: Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series.
abstract: Anastomotic leakages are severe and often lethal adverse events of surgery for esophageal cancer. The endoscopic treatment is growing up in such indications. The aim was to evaluate the efficacy and describe the strategy of the endoscopic management of anastomotic leakages/fistulas after esophageal oncologic surgery.
  
  
  
  Single-center retrospective study on 126 patients operated for esophageal carcinomas between 2010 and 2014. Thirty-five patients with postoperative fistulas/leakages (27 %) were endoscopically managed and included. The primary endpoint was the efficacy of the endoscopic treatment. The secondary endpoints were: delays between surgery, diagnosis, endoscopy and recovery; number of procedures; material used; and adverse events rate. Uni- and multivariate analyses were carried out to determine predictive factors of success.
  
  
  
  There were mostly men, with a median age of 61.7 years ± 8.9 [43-85]. 48.6 % underwent Lewis-Santy surgery and 45.7 % Akiyama's. 71.4 % patients received neo-adjuvant chemo-radiation therapy. The primary and secondary efficacy was 48.6 and 68.6 %, respectively. The delay between surgery and endoscopy was 8.5 days [6.00-18.25]. Eighty-eight percentages of the patients were treated using double-type metallic stents, with removability and migration rates of 100 and 18 %, respectively. In the other cases, we used over-the-scope clips, naso-cystic drain or combined approach. The mean number of endoscopy was 2.6 ± 1.57 [1-10]. The mortality rate was 17 %, none being related to procedures. No predictive factor of efficacy could be identified.
  
  
  
  The endoscopic management of leakages or fistulas after esophageal surgery reached an efficacy rate of 68.8 %, mostly using stents, without significant adverse events. The mortality rate could be decreased from 40-100 to 17 %.
authors.affiliation: Department of Gastroenterology, APHM, North Hospital, University of Mediterranean, Chemin des Bourrelys, 13915, Marseille, France. jmgonza05@yahoo.fr.
authors.forename: Jean-Michel
authors.identifier: 0000-0001-5772-8236
authors.initials: JM
authors.lastname: Gonzalez
authors.affiliation: Department of Gastroenterology, APHM, North Hospital, University of Mediterranean, Chemin des Bourrelys, 13915, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Servajean
authors.affiliation: Department of Gastroenterology, APHM, North Hospital, University of Mediterranean, Chemin des Bourrelys, 13915, Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Aider
authors.affiliation: Department of Gastroenterology, APHM, North Hospital, University of Mediterranean, Chemin des Bourrelys, 13915, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Gasmi
authors.affiliation: Department of Thoracic Surgery, APHM, North Hospital, University of Mediterranean, Marseille, France.
authors.forename: X B
authors.initials: XB
authors.lastname: D'Journo
authors.affiliation: Intensive Care Unit, APHM, North Hospital, University of Mediterranean, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of Gastroenterology, APHM, North Hospital, University of Mediterranean, Chemin des Bourrelys, 13915, Marseille, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Grimaud
authors.affiliation: Department of Gastroenterology, APHM, North Hospital, University of Mediterranean, Chemin des Bourrelys, 13915, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004724:Endoscopy; D004937:Esophageal Fistula / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: Anastomotic fistula; Esophageal carcinomas; Esophageal surgery; Leakage; Stenting; Therapeutic endoscopy