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Background/Objective Radiotherapy is a common treatment for patients with esophageal cancer. Esophageal fistula (perforation) is a serious complication in patients with advanced esophageal cancer. It is unclear how radio/chemotherapy post-fistula may affect survival in patients with malignant esophageal fistulae with radiotherapy pre-fistula. We sought to evaluate radio/chemotherapy and survival post-fistula in patients with esophageal cancer and radiotherapy pre-fistula. Methods In a retrospective cohort study, we reviewed post-fistula treatments and survival in 98 patients with esophageal cancer and prior radiotherapy with or without chemotherapy between 2010/6 and 2023/5 in a regional cancer care centre in Zhengzhou, China. The primary outcome was survival time (months) post-fistula. The inverse of the probability of treatment weighting (IPTW) was applied in Cox regression models in assessing the association between post-fistula radio/chemotherapy and survival accounting for baseline clinical risk factors. Results The median survival time post-fistula was 3.5 months (inter-quartile range: 1.4–7.8 months). Compared to patients without radio/chemotherapy post-fistula, longer survival was observed in patients with radiotherapy [adjusted HR 0.40 (95% CI 0.20–0.80)], chemotherapy [adjusted HR 0.24 (0.08–0.72)], or chemo and radiotherapy [adjusted HR 0.10 (0.05–0.19)] post-fistula. Among patients with radiotherapy post-fistula, longer survival was observed in patients with both chemo and radiotherapy [adjusted HR 0.18 (0.08–0.36)] than with radiotherapy only. Conclusions In patients with malignant esophageal fistulae and radiotherapy pre-fistula, continued radiotherapy post-fistula may improve survival, and combined radio/chemotherapy may be beneficial to optimal survival.

Limited studies have focused on the prognostic factors of esophageal respiratory fistula (ERF) associated with radiotherapy in patients with unresectable esophageal squamous cell carcinoma (ESCC). Between January 1st, 2014 and January 1st, 2021, we included patients who were initially diagnosed with unresectable ESCC and underwent radiotherapy. All patients were followed up for a period of 2 years after completing their radiotherapy treatment. The primary outcomes of the study were defined as death or severe adverse events. The survival curves of ERF were calculated using the Kaplan–Meier method. Cox proportional hazards model was employed to calculated the prognostic factors. A cohort of 232 patients underwent radiotherapy, of whom 32 patients experienced ERF. The median period from initial diagnosis of ESCC to ERF was 5.75 months, and the median period from ERF to the primary outcome was 4.6 weeks. Neck + upper chest location (odds ratio [OR] 3.305), high T stage (OR 1.765), esophageal stenosis (OR 1.073), high neutrophil to lymphocyte ratio (NLR) (OR 1.384) and platelet to lymphocyte ratio (PLR) (OR 1.765) were risk factors for the occurrence of ERF. Cox regression analysis suggested that tumor location (hazards ratio [HR] 3.572, 95% confidence interval [CI] 2.467–5.1), high T stage (HR 4.050, 95% CI 2.812–5.831), esophageal stenosis (HR 2.643, 95% CI 1.753–3.983), high PLR (HR 2.541, 95% CI 1.868–3.177) were independent prognostic factors for poor survival. Esophageal stenosis, neck + upper chest tumor location, high T stage and PLR predicted the prognosis of ERF in ESCC patients undergoing radiotherapy.

Background Standard treatment for unresectable esophageal squamous cell carcinoma (ESCC) without distant metastasis is definitive chemoradiotherapy (dCRT), in which the incidence of esophageal fistula (EF) is reported to be 10–12%. An ad hoc analysis of JCOG0303, a phase II/III trial of dCRT for patients with unresectable ESCC (including non-T4b), suggested that esophageal stenosis is a risk factor for EF. However, risk factors for EF in patients limited to T4b ESCC treated with dCRT have yet to be clarified. The aim of this study was to investigate risk factors for EF in T4b thoracic ESCC treated with dCRT. Methods We retrospectively analyzed the data of consecutive T4b thoracic ESCC patients who were treated with dCRT (cisplatin and fluorouracil) at Shizuoka Cancer Center between April 2004 and September 2015. Results Excluding 8 patients with esophageal fistula clearly attributable to other iatrogenic interventions, the data of 116 patients who met the inclusion criteria were analyzed. Esophageal fistula was observed in 28 patients (24%). Although the fistula was closed in 5 patients, overall survival was significantly shorter in patients who experienced esophageal fistula (8.0 vs. 26.8 months; p  < 0.0001). Among four potential variables extracted in univariate analysis, namely, total circumferential lesion, elevated CRP level, elevated white blood cell count, and anemia, the first two were revealed as risk factors for esophageal fistula in multivariate analysis. Conclusions This study demonstrated that total circumferential lesion and CRP ≥1.00 mg/dL are risk factors for esophageal fistula in T4b thoracic ESCC treated with dCRT. Trial registration This study was retrospectively registered.

Cancers arising from the esophagus, including the gastroesophageal junction, are relatively uncommon in the United States — the lifetime risk of this cancer is 0.8 percent for men and 0.3 percent for women, and it increases with age. The presentation is insidious; at diagnosis, more than 50 percent of patients have either unresectable cancer or radiographically visible metastases, rendering management problematic. This review discusses the pathogenesis of esophageal cancer, as well as the clinical presentation, treatment, and prognosis. Esophageal cancer is one of the least studied and deadliest cancers worldwide. During the past three decades, important changes have occurred in the epidemiologic patterns associated with this disease. Recent advances in the diagnosis, staging, and treatment of this neoplastic condition have led to small but significant improvements in survival. These new observations serve as the focus of this review. Incidence Cancers arising from the esophagus, including the gastroesophageal junction, are relatively uncommon in the United States, with 13,900 new cases and 13,000 deaths anticipated in 2003. 1 The lifetime risk of this cancer is 0.8 percent for men and 0.3 . . .

An 11-month-old girl presented with a 2-week history of progressive dysphagia and cough. A chest radiograph showed a foreign body with a “double-ring” sign. Torrential hematemesis subsequently developed.

ObjectiveThis study aimed to develop a prediction model for esophageal fistula (EF) in esophageal cancer (EC) patients treated with intensity-modulated radiation therapy (IMRT), by integrating multi-omics features from multiple volumes of interest (VOIs).MethodsWe retrospectively analyzed pretreatment planning computed tomographic (CT) images, three-dimensional dose distributions, and clinical factors of 287 EC patients. Nine groups of features from different combination of omics [Radiomics (R), Dosiomics (D), and RD (the combination of R and D)], and VOIs [esophagus (ESO), gross tumor volume (GTV), and EG (the combination of ESO and GTV)] were extracted and separately selected by unsupervised (analysis of variance (ANOVA) and Pearson correlation test) and supervised (Student T test) approaches. The final model performance was evaluated using five metrics: average area under the receiver-operator-characteristics curve (AUC), accuracy, precision, recall, and F1 score.ResultsFor multi-omics using RD features, the model performance in EG model shows: AUC, 0.817 ± 0.031; 95% CI 0.805, 0.825; p < 0.001, which is better than single VOI (ESO or GTV).ConclusionIntegrating multi-omics features from multi-VOIs enables better prediction of EF in EC patients treated with IMRT. The incorporation of dosiomics features can enhance the model performance of the prediction.

Atrioesophageal Fistula is a rare complication after radiofrequency catheter ablation. In this article, we report a case of atrioesophageal fistula, confirmed by a Chest computed tomography scan and treated by two-stage surgical repair. In addition, we review the case reports about atrioesophageal Fistula in PubMed, with the aim of presenting here our experience and sharing our surgical approach. The methods of treatment and prevention of such complication are also reviewed in this article.

BackgroundGastrointestinal fistulization (GIF) is a rare and potentially fatal complication of acute necrotizing pancreatitis (ANP). There is paucity of data on clinical course and outcome of GIF in walled of necrosis (WON).ObjectiveTo evaluate frequency, clinical as well as imaging findings and outcome of spontaneous symptomatic GIF in patients with WON.MethodsRetrospective analysis of database of patients with asymptomatic WON on regular follow-up over last six years to identify patients with symptomatic GIF.ResultsOut of 138 patients with asymptomatic WON seen during the study period, 16 (11.5%) patients (all males; mean age 41.7 ± 9.9 years) developed symptomatic GIF. The mean size of WON in patients who developed GIF was 9.5 ± 2.4 cm, and fistulization occurred after 65.1 ± 17.8 days of the onset of ANP. The site of fistulization was stomach, duodenum, jejunum, colon, and esophagus in seven (43.7%), five (31.2%), one (6.2%), two (12.5%), and one (6.2%) patients, respectively. GIF resulted in spontaneous resolution in two patients (stomach 1 and esophagus 1). The remaining patients with gastric (six patients) and duodenal (five patients) fistulization were successfully treated endoscopically by placing multiple plastic stents in the necrotic cavity after balloon dilatation of the fistulous tract. Patients with colonic fistulization required surgery. None of the patients succumbed to the illness.ConclusionSymptomatic GIF of WON usually occurs within the first three months of onset of ANP. It commonly occurs in either stomach or duodenum and can be successfully managed endoscopically.

BackgroundEsophageal perforation and fistula formation are rare but serious complications following atrial fibrillation ablation. In this review article, we outline the incidence, pathophysiology, predictors, and preventative strategies of this dreaded complication.MethodsWe conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles reporting complications following atrial fibrillation ablation, including esophageal injury and fistula formation, were included for systematic review.ResultsA total of 130 manuscripts were identified for the final review process. The overall incidence of esophageal injury following atrial fibrillation ablation was significantly higher with thermal ablation modalities (radiofrequency 5–40%, cryoballoon 3–25%, high-intensity focused ultrasound < 10%) as opposed to non-thermal ablation modalities (no cases reported to date). The incidence of esophageal perforation and fistula formation with the use of thermal ablation modalities is estimated to occur in less than 0.25% of all atrial fibrillation ablation procedures. The use of luminal esophageal temperature monitoring probe and mechanical esophageal deviation showed protective effect toward reducing the incidence of this complication. The prognosis is very poor for patients who develop atrioesophageal fistula, and the condition is rapidly fatal without surgical intervention.ConclusionsEsophageal perforation and fistula formation following atrial fibrillation ablation are rare complications with poor prognosis. Various strategies have been proposed to protect the esophagus and reduce the incidence of this fearful complication. Pulsed field ablation is a promising new ablation technology that may be the future answer toward reducing the incidence of esophageal complications.The recognition of risk factors and preventative strategies of esophageal injury, perforation, and fistula formation following atrial fibrillation ablation is essential to reduce the incidence of this dreaded complication (online abstract figure).