The impact of endoscopic closure treatment on outcomes in patients with esophageal cancer-associated fistula: A retrospective analysis

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 versus 2; P=0.004) but did not influence survival or fistula healing outcomes, and the hospitalization costs were elevated ($6653 versus $3350; 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 doesn't significantly enhance long-term healing or survival prognosis.