Andrew Han, MD1, Feenalie Patel, MD1, Adil Ghafoor, MD2, Daanish Siddique, MD1, Benjamin L. Bick, MD3, Mohammad Al-Haddad, MD, FACG3
1Indiana University, Indianapolis, IN; 2St. Vincent's Hospital, Indianapolis, IN; 3Indiana University School of Medicine, Indianapolis, IN
Introduction: Previously, surgical management represented the mainstay of therapy for esophageal defects such as tracheoesophageal fistulas, perforations, and post-operative leaks. As technical improvements in devices and endoscopic techniques improved, non-surgical management options increased to include clips, fibrin glue, and endoscopic suturing. Hybrid therapy involving both primary closure of the defect with endoscopic suturing and esophageal stent placement to protect the site was investigated.
Methods: We report a single center experience on dual modal therapy with endoscopic suturing and esophageal stenting for management of esophageal defects including tracheoesophageal fistulas, perforations, and post-operative leaks from 2013 to 2019. Factors such as etiology of defect (spontaneous perforation, iatrogenic perforation, tracheoesophageal fistula), size of defect, prior esophageal surgeries, and other factors were evaluated. Resolution was confirmed using esophagram to rule out leaks.
Results: 18 patients underwent dual modality therapy with primary closure using endoscopic suturing with concurrent esophageal stenting. Mean length of defects was 14.5 mm. 2 patients were lost to followup, and 1 patient was excluded because they underwent thoracostomy for concomitant therapy. Of the 15 patients left for analysis, successful closure was achieved in 14 patients.There were no significant complications related to the procedures.
Discussion: Early data from dual modality therapy from our single center report appear positive, however, there have not been enough cases to provide sufficient statistical analysis. Still, our combined approach show promising rates of success with minimal adverse effects. Further investigation comparing dual modality therapy with standard therapy are planned to be performed.
Citation: Andrew Han, MD; Feenalie Patel, MD; Adil Ghafoor, MD; Daanish Siddique, MD; Benjamin L. Bick, MD; Mohammad Al-Haddad, MD, FACG. P1474 - DUAL MODALITY THERAPY FOR ENDOSCOPIC MANAGEMENT OF ESOPHAGEAL DEFECTS. Program No. P1474. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.