Endoprosthetics for the treatment of esophageal leaks and fistula

Esophageal leaks, perforations, and fistula represent life-threatening complications, with a reported mortality of 12%-50% in the surgical literature. Endoscopic treatment by stenting has been reported in a large number of patients with good outcomes. The principles of this method might be described with the acronym DCWR (drain, close, water-tightness, and remove). Briefly, after the drainage of associated collections, the insertion of a self-expandable esophageal stent across the leakage region enables diversion of the esophageal contents from the wound cavity. When the stent allows water-tightness, the leak closes by second intention. Some weeks later, the stent is removed. The global sealing rate and clinical success reaches 79% and 76%, respectively, in pooled data analysis of available published cohorts. Reported mortality is approximately 11%. We reviewed the details of published cohorts emphasizing on the factors associated with endoscopic treatment success, the stent choice in respect to relative advantages and complications, the removal protocols, and development perspectives.