The best endoscopic method to close refractory esophageal fistula: vacuum? clips? stenting? sheet? glue? ablation?

Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta‐analysis

“…Gastrointestinal transmural defects can be classified into three distinct entities – fistulas, leaks and perforations 1 . While several treatment modalities are available, including both surgical and endoscopic approaches, the results of the success and safety of these modalities are conflicting, and physicians are consistently searching for safer and more effective strategies 25–27 …”

“…1 While several treatment modalities are available, including both surgical and endoscopic approaches, the results of the success and safety of these modalities are conflicting, and physicians are consistently searching for safer and more effective strategies. [25][26][27] The usage of stents for upper gastrointestinal transmural defects has already been validated in the literature. 3 Selfexpandable metal and plastic stents can both be used, although metal stents are the more commonly applied device.…”

Acquired Benign Tracheoesophageal Fistula

“…11 Both bare-metal as well as fully covered stents have been successfully used for management of TEFs but potential stent-related complications such as perforation, stent migration, plugging, foreign body sensation and retrosternal pain often limit their use. 5,12,13 Additional occlusive devices such as the Cardiac Septal Occluder device, the Amplatzer (St. Jude Medical, Plymouth, MN) have been used to seal TEFs. This is a shape-memory, self-expanding double-disk device composed of nitinol and interwoven polyester, which promotes occlusion and tissue in-growth.…”

“…Options include covered self-expanding metal stents, silicone, or hybrid stents 11. Both bare-metal as well as fully covered stents have been successfully used for management of TEFs but potential stent-related complications such as perforation, stent migration, plugging, foreign body sensation and retrosternal pain often limit their use 5,12,13. Additional occlusive devices such as the Cardiac Septal Occluder device, the Amplatzer (St. Jude Medical, Plymouth, MN) have been used to seal TEFs.…”

“…This is a shape-memory, self-expanding double-disk device composed of nitinol and interwoven polyester, which promotes occlusion and tissue in-growth 9. These features may allow the device to manage fistulas with irregular margins and epithelized tracts and those in edematous or scarred tissues, which are less amenable to clipping, suturing, or stenting with reported clinical success rate of about 50% especially in cases with acute esophageal leaks 12. One case series described device migration and fistula enlargement from airway erosion demonstrating the complexity of utilizing the Amplatzer device for TEF 9,14…”