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Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs. [ABSTRACT FROM AUTHOR]

Patients with malignant esophageal fistulas often experience dysphagia and infection, resulting in poor prognoses. Self-expandable metallic stent (SEMS) placement is a palliative treatment option; however, its efficacy and safety are unclear. We aimed to determine the efficacy and safety of SEMS placement for malignant esophageal fistulas. We retrospectively investigated patients who underwent SEMS placement for malignant esophageal fistulas between 2013 and 2022 at the Cancer Institute Hospital. Dysphagia scores (DSs) before and after SEMS placement, adverse events, and overall survival from SEMS placement until death were evaluated. A total of 17 patients underwent SEMS placement, including 12 and 5 patients with esophageal and lung cancers, respectively. Prior treatments included chemoradiotherapy (n = 11), radiotherapy (n = 4), and chemotherapy (n = 4); two patients underwent palliative radiotherapy after chemotherapy. All procedures were technically successful. After SEMS placement, 14 (82.4%) patients were able to consume semisolid or solid food (DS ≤ 2). Major adverse events were encountered in only one case. The median survival time after SEMS placement was 71 days (range 17–247 days). SEMS placement allowed most patients to resume oral intake with a low rate of major adverse events. SEMS placement is a reasonable palliative treatment option for patients with malignant fistulas who have poor prognoses. [ABSTRACT FROM AUTHOR]

A 50-year-old woman accidentally swallowed a fish bone that punctured her vertebral artery, leading to successful surgical repair involving multiple medical specialties. The fish bone was identified through urgent computed tomography, and after emergency exploratory surgery, a vertebral artery stent graft was placed to stop the bleeding. This case highlights the potential complications of swallowing foreign objects and the successful surgical intervention in this unique situation, with the patient recovering well at the 6-month follow-up. [Extracted from the article]

Concurrent chemoradiotherapy (CCRT) is the standard treatment for unresectable locally advanced esophageal squamous cell carcinoma (LA-ESCC), yet its 5-year overall survival (OS) is below 30%. In the era of immunotherapy, neoadjuvant immunochemotherapy (ICT) has demonstrated promising outcomes in resectable LA-ESCC, thus we extended this strategy to unresectable LA-ESCC by incorporating induction ICT before definitive CCRT. It is hypothesized that induction ICT can reduce tumor burden and target volume in CCRT. Besides, early intervention of ICT may eliminate micro-metastases, enhancing overall treatment efficacy. In this study, we assessed the safety and effectiveness of induction ICT followed by CCRT in patients with unresectable LA-ESCC. Patients aged over 18 with untreated, inoperable LA-ESCC were recruited for this trial. Two cycles of ICT (nab-paclitaxel 200mg/m2 d1 q3w + carboplatin AUC = 5 d1 q3w + PD-1 inhibitor 200mg d1 q3w) were administered before CCRT (50.4Gy/28Fx; paclitaxel liposome 50mg/m2 d1 qw + carboplatin AUC = 2 d1 qw for 5-6 cycles). Subsequently, patients were given consolidation immunotherapy for up to one year. The primary endpoint was 1-year OS, and secondary endpoints included safety, progression-free survival (PFS) and objective response rate (ORR). Safety was evaluated by grade 3 or higher adverse events (AEs) according to Common Terminology Criteria for Adverse Events (CTCAE) 5.0. The Kaplan-Meier method was used to estimate OS and PFS. Between May 2021 and November 2023, 51 patients (median age 67, 88.2% male) in stage II-IVB were enrolled. 50 (98.0%) patients completed 2 cycles of ICT and 48 (94.1%) underwent CCRT. Among these patients, 44 (91.7%) completed the radiotherapy, but only 29 (60.4%) were able to complete 5 or more cycles of weekly concurrent chemotherapy. Evaluation after CCRT revealed an ORR of 91.7%. After a median follow-up of 12 months, the 1-year PFS was 76%, and 1-year OS was 92.9%. Median PFS and OS were not reached. 13 patients (25.5%) and 40 patients (83.3%) had grade 3 or above AEs during ICT and CCRT, respectively. Common grade 3 or above AEs included lymphopenia (78.4%), leukopenia (31.4%), neutropenia (17.6%), thrombocytopenia (11.8%), anemia (9.8%) and esophagitis (5.9%). One patient died from esophageal fistula. Preliminary findings from the trial indicated both favorable safety profiles and promising efficacy of integrating induction ICT prior to CCRT as the first-line treatment for unresectable LA-ESCC. Long-term survival benefits require further follow-up. [ABSTRACT FROM AUTHOR]

Immediate intervention is needed for aortoesophageal fistulas (AEF), a rare but highly lethal cause of massive gastrointestinal hemorrhage. Emergent thoracic endovascular aortic repair (TEVAR) is considered first-line treatment for massive bleeding from AEFs. We describe an unusual and challenging case of TEVAR coverage of an AEF involving the central aortic arch immediately followed by in vivo endograft fenestration to regain arch vessel perfusion. In vivo fenestration, currently a procedure for emergency or investigational purposes only, was shown to be life saving in our case. The main complications associated with the procedure included stroke and infection, requiring esophagectomy and cervical diversion as well as ongoing antibiotic treatment.

An introduction is presented in which the editor discusses articles in the issue on topics including Farapulse Pulse Field Ablation (PFA) System Thermal and Pathological Changes, Esophageal Temperature Changes Recorded by Circa Scientific Probe (Kirstein et al.), and other related subjects.

Objective: This study aims to discuss the appropriate treatment of esophageal fistula following anterior surgery for cervical spine fracture. Methods: Clinical data of patients with cervical spine fracture treated at our research center from January 2000 to December 2019 were screened. Data of patients with esophageal fistula were included, and the causes of injury, diagnosis, and treatment were retrospectively analyzed. Results: A total of 3578 patients with cervical spine fracture were screened, among whom there were 10 cases (0.28 %) of esophageal fistula. 60 % of the cases were early-onset and all were caused by intraoperative electric knife injury. The positive rate of early endoscopy was only 25 %, while routine radiography showed a positive rate of 33.3 % after three attempts. Among the six patients with early-onset esophageal fistula, three underwent sternocleidomastoid flap transfer and two underwent primary suture, all achieving successful healing. In the four cases of late-onset esophageal fistula, two patients received implant removal, debridement, incision lavage, and sternocleidomastoid muscle flap transfer three weeks later. One patient received implant removal, debridement, vacuum sealing drainage, followed by sternocleidomastoid muscle pedicle transfer muscle flap plus lavage two weeks later and achieved complete recovery. All patients gargled alternately with metronidazole and chlorhexidine gargle after surgery. Conclusion: The occurrence of esophageal fistula is associated with surgical procedures, esophageal injury, and implant compression. Esophagography and endoscopy are the primary diagnostic methods, while incision exploration after ingestion of food mixed with methylene serves as a supplementary approach. Recommended treatments include alternating metronidazole and chlorhexidine gargles, esophageal rest, repair of the fistula, muscle flap packing, lavage and drainage, nutritional support, and removal of internal fixation if necessary. Post-surgery administration of antibiotics should continue until three consecutive lavage cultures yield negative results.

Aims Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0–60) days and 21 (15, 29.5; range: 2–63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0–42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high. [ABSTRACT FROM AUTHOR]

Salvage surgery for esophageal cancer after definitive chemoradiotherapy (dCRT) is effective, but it is associated with a high rate of perioperative complications. The indications for robot‐assisted minimally invasive esophagectomy (RAMIE) are expanding. However, there are few reports of salvage RAMIE. A 73‐year‐old man was referred to our hospital for residual esophageal cancer with a mediastinal fistula after dCRT. The perioperative diagnosis was T3N1M0‐Stage III, and the salvage RAMIE was performed. Although the dissection was difficult due to fibrosis caused by dCRT and the esophageal mediastinal fistula, RAMIE was performed safely with no complications. Multiple features of RAMIE contributed to stable surgery. The monopolar dissection is effective for hard scar tissue caused by CRT and inflammation. [ABSTRACT FROM AUTHOR]

Background: Studies on neurodevelopmental outcomes in individuals with congenital anomalies who undergo neonatal surgery are scarce and have reported contradictory findings based on small study groups. The congenital condition VACTERL association includes at least three malformations: vertebral anomalies, anorectal malformations, cardiac defects, tracheoesophageal fistula with or without esophageal atresia, renal anomalies and limb deformities. Most of these patients undergo surgery during their first days of life. Neurodevelopmental disorders include a broad group of disabilities involving some form of disruption to brain development. Attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability (ID) are diagnoses included in this group. The aim of the study was to investigate the risk of ADHD, ASD and ID in a cohort of individuals with VACTERL association. Method: Data was obtained from four Swedish national health registers and analyzed using the Cox proportional hazards model. Patients born 1973–2018 in Sweden with the diagnosis of VACTERL association were included in the study. For each case five healthy controls matched for sex, gestational age at birth, birth year and birth county were obtained. Results: The study included 136 individuals with VACTERL association and 680 controls. Individuals with VACTERL had significantly higher risk of ADHD, ASD and ID than the controls; 2.25 (95% CI, 1.03–4.91), 5.15 (95% CI, 1.93–13.72) and 8.13 (95% CI, 2.66–24.87) times respectively. Conclusions: A higher risk of ADHD, ASD and ID was found among individuals with VACTERL association compared to controls. These results are of importance to caregivers and to professionals participating in follow ups of these patients in providing early diagnosis and support, aiming to optimize the quality of life of these patients. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Atrial fibrillation is a common arrhythmia worldwide. The number of patients undergoing ablation as treatment is increasing, as is the incidence of complications from ablation. One such complication is atrio-esophageal fistula, which is rare but life threatening. We discuss 2 cases of patients that presented with a fistula several weeks following atrial fibrillation ablation. Case Reports: A 67-year-old man and 64-year-old woman both had cardiovascular morbidity and chronic kidney disease, diabetes, and other chronic illnesses. Both patients presented approximately 6 weeks after radiofrequency atrial fibrillation ablation and were admitted with varying symptoms, including fever and neurological deficits mimicking a cerebrovascular accident or massive bleeding. Both patients deteriorated very rapidly in the department, especially after certain interventions, such as endoscopy, and exhibited deteriorating neurological signs, including loss of consciousness and basic brain stem reflexes, and head computed tomography (CT) showed widespread infarcts and hemorrhages. Owing to their history, a chest CT was performed at the same time, revealing an atrio-esophageal fistula, which was determined to be the cause of their illness and led to their eventual deaths. Conclusions: A rare complication of atrial fibrillation ablation procedure is atrio-esophageal fistula, which if left untreated, is almost uniformly fatal, and even survivors are usually left with significant sequelae. It is important to recognize the rapid deterioration and possible signs and symptoms, such as gastrointestinal bleeding, fever, or even neurological abnormalities, and make the connection to the ablation procedure in terms of timeline for rapid diagnosis and prompt treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Esophageal fistula is one of the most serious complications of chemotherapy or chemoradiotherapy (CRT) for advanced esophageal cancer. This study aimed to evaluate the performance of quantitative computed tomography (CT) analysis and to establish a practical imaging model for predicting esophageal fistula in esophageal cancer patients treated with chemotherapy or chemoradiotherapy. Methods This study retrospectively enrolled 204 esophageal cancer patients (54 patients with fistula, 150 patients without fistula) and all patients were allocated to the primary and validation cohorts according to the time of inclusion in a 1:1 ratio. Ulcer depth, tumor thickness and length, and minimum and maximum enhanced CT values of esophageal cancer were measured in pretreatment CT imaging. Logistic regression analysis was used to evaluate the associations of CT quantitative measurements with esophageal fistula. Receiver operating characteristic curve (ROC) analysis was also used. Results Logistic regression analysis showed that independent predictors of esophageal fistula included tumor thickness [odds ratio (OR) = 1.167; p = 0.037], the ratio of ulcer depth to adjacent tumor thickness (OR = 164.947; p

Introduction: There is currently no validated diagnostic modality to characterize the anatomy and predict outcomes of tracheal esophageal defects, such as esophageal atresia (EA) and tracheal esophageal fistulas (TEFs). We hypothesized that ultra-short echo-time MRI would provide enhanced anatomic information allowing for evaluation of specific EA/TEF anatomy and identification of risk factors that predict outcome in infants with EA/TEF. Methods: In this observational study, 11 infants had pre-repair ultra-short echo-time MRI of the chest completed. Esophageal size was measured at the widest point distal to the epiglottis and proximal to the carina. Angle of tracheal deviation was measured by identifying the initial point of deviation and the farthest lateral point proximal to the carina. Results: Infants without a proximal TEF had a larger proximal esophageal diameter (13.5 ± 5.1 mm vs. 6.8 ± 2.1 mm, p = 0.07) when compared to infants with a proximal TEF. The angle of tracheal deviation in infants without a proximal TEF was larger than infants with a proximal TEF (16.1 ± 6.1° vs. 8.2 ± 5.4°, p = 0.09) and controls (16.1 ± 6.1° vs. 8.0 ± 3.1°, p = 0.005). An increase in the angle of tracheal deviation was positively correlated with duration of post-operative mechanical ventilation (Pearson r = 0.83, p < 0.002) and total duration of post-operative respiratory support (Pearson r = 0.80, p = 0.004). Discussion: These results demonstrate that infants without a proximal TEF have a larger proximal esophagus and a greater angle of tracheal deviation which is directly correlated with the need for longer post-operative respiratory support. Additionally, these results demonstrate that MRI is a useful tool to assess the anatomy of EA/TEF. [ABSTRACT FROM AUTHOR]

Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency ablation (RFCA) for atrial fibrillation (AF) and is associated with high mortality rates. Whereas most cases of AEF are treated by emergency surgical interventions, we report a case of paroxysmal AF with AEF after combined therapy of catheter ablation and percutaneous left atrial appendage closure (LAAC), which was treated successfuly without major surgery or esophageal stenting. He was presented 18 days after the procedure, suffering chest pain, fever, and a transient loss of consciousness. Computed tomography (CT) of the chest disclosed a small accumulation of air in the region of the left atrium adjacent to the esophagus, suggesting AEF. Supported by early aggressive antibiotic therapy, pericardial drainage and a fasting state with adequate parenteral nutrition, resulted in improvement of his condition with no recurrence of symptoms. Subsequent chest CT scans confirmed disappearance of the leaked air and the patient was discharged home 28 days after admission with no neurological compromise. Early detection, rapid treatment and constant awareness of potential fatal consequences are prerequisites for successful treatment of this complication and prevention of fatal outcome. [ABSTRACT FROM AUTHOR]

Background: With the increasing incidence of upper digestive tract tumors, more upper digestive tract surgeries are performed each year, and surgeons have difficulty in the postoperative management of gastrointestinal anastomotic fistula. The use of a new minimally invasive technique, endoluminal vacuum-assisted closure (E-VAC), has increased the success rate of the treatment of gastrointestinal fistula. Methods: We present 6 cases of gastrointestinal fistula treated in our hospital in 2021: 3 cases of anastomotic fistula after esophageal cancer surgery, 2 cases of anastomotic fistula after gastric cancer surgery, and one case of esophageal rupture after trauma. With E-VAC and other adjuvant treatment measures, the gastrointestinal fistulas were eventually closed or significantly reduced. Results: Both local and systemic infections in all 6 patients were controlled with the use of E-VAC device, resulting in significant reduction or closure of fistulas. Conclusion: E-VAC devices can effectively help in the removal of the exudate and necrotic tissue around the fistula, promote the proliferation of granulation tissue, and support closure of the fistula. However, further improvements to the device are needed to improve patient comfort and operational safety. [ABSTRACT FROM AUTHOR]

Minimally invasive surgeries have been developed, not only for gastrointestinal cancer, but also for benign or emergency cases. We report the case of a 62‐year‐old male who underwent laparoscopic and thoracoscopic combined surgery for an esophago‐mediastinal fistula caused by a press‐through package. In the initial laparoscopic phase, transhiatal dissection of the lower thoracic esophagus and harvesting of the greater omentum were performed. In the thoracoscopic phase, resection of the fistula and esophageal wall closure were performed. Thereafter, the greater omentum was lifted via the esophageal hiatus and wrapped around the repaired part of the esophagus for reinforcement. The total operative time was 371 min, with 163 and 208 min for the laparoscopic and thoracoscopic phases, respectively. In total, 20 ml of blood was lost. No perioperative complications or recurrences were observed. Laparoscopic and thoracoscopic combined omentoplasty was effective for refractory esophago‐mediastinal fistula. [ABSTRACT FROM AUTHOR]

EEC syndrome is an autosomal dominant genetic disease with incomplete penetrance characterized by ectrodactyly, ectodermal dysplasia, and cleft lip/palate; these manifestations can differently occur in the affected subjects and can also be associated with other anomalies, such as in the urogenital tract. We reported the case of a newborn with prenatal diagnosis of EEC type 3 associated with severe cardiac abnormalities (Tetralogy of Fallot), high esophageal atresia with fistula and penoscrotal hypospadias. [ABSTRACT FROM AUTHOR]

Background and Aim: Esophageal obstruction is a common occurrence and a serious condition in camels. This study aimed to assess the effects of mineral deficiency on esophageal obstruction rates in dromedary camels and describe their clinical presentation and treatment outcomes. Materials and Methods: Twenty-eight camels were allocated to two groups. Group 1 (control) was composed of 10 sound camels. Group 2 included 18 camels with esophageal obstruction which were based on clinical and imaging evaluations. Hematobiochemical examinations in control and affected camels were compared and statistically analyzed. Results: In camels with esophageal obstruction when compared with controls, hematological analyses showed significant increases (p < 0.05) in neutrophils, lymphocytes, and monocytes, along with significantly decreased total white blood counts. Aspartate transaminase, alanine transaminase, alkaline phosphatase, creatine phosphokinase, glucose, albumin, creatinine, and blood urea nitrogen concentrations were significantly higher in affected camels when compared with controls. Furthermore, gamma-glutamyl transferase, globulin, sodium, chloride, cobalt, iron, manganese, and selenium concentrations were significantly reduced. Affected camels were treated by stomach tube or surgery and were completely recovered, except for one camel with an esophageal fistula. Conclusion: A lack of trace elements could have a significant role in esophageal obstruction in dromedaries. Clinical, ultrasonographic, and hematobiochemical evaluations are useful for the accurate diagnosis, prognosis, and treatment of esophageal obstruction in camels. [ABSTRACT FROM AUTHOR]

Background and objectives: Submucosal tunnel endoscopic resection (STER) is an effective technique for treating esophageal submucosal tumors, but the efficacy and safety of treating esophageal submucosal tumors with internal traction method-assisted STER have not been determined. The objectives of this study were to assess the feasibility, safety, and efficacy of internal traction method-assisted STER for the removal of esophageal submucosal tumors. Patients and methods: Eighty patients who underwent STER for esophageal submucosal tumors were included in the study. They were randomized and assigned to the two groups. The dual-knife method was used for STER. Forty patients underwent conventional STER (control group) and 40 underwent internal traction method-assisted STER in which self-made rubber band traction with clips was used (study group). In the study group, one end of the self-made rubber band was fixed on the surface of esophageal submucosal tumors with a clip, and the other end of the self-made rubber band was set on the anal side of the contralateral esophageal wall with a clip. Results: STER was successful in all cases. Lesion features and demographics were similar between the two groups. In addition, broad exposure of the submucosal tissue was obtained by applying tension to the self-made rubber band traction with clips. The en bloc resection rate and complete resection rate were both 100% in the study group. However, the en bloc resection rate and complete resection rate were 85.0% and 100%, respectively, in the control group. Complications, such as perforation and pneumomediastinum, were significantly reduced in the study group, and there was a significant difference in the number of occurrences of bleeding, operation duration, fasting time, and patient length of stay between the study group and control group (P < 0.05). During the mean 13.7 month follow-up, there were no patients with esophageal fistula, recurrence, or distant metastasis in either group. Conclusions: This original study showed that esophageal submucosal tumors could be effectively and safely treated with internal traction method-assisted STER, and this technique might be superior to conventional STER due to its fewer complications, shorter operation duration, and shorter inpatient length of stay. [ABSTRACT FROM AUTHOR]

Esophageal fistula remains one of the main postoperative complications, with the treatment often requiring the use of stents. This article reviews the updates on the use of endoscopic stents for the treatment of postoperative esophageal leakage in terms of indications, types of stents used, efficiency, specific complications and perspectives. Materials and Methods: We searched the PubMed and MEDLINE databases for the keywords postoperative esophageal anastomotic leak and postoperative esophageal anastomotic leak stent, and retrieved relevant papers published until December 2022. Results: The endoscopic discovery of the fistula is usually followed by the insertion of a fully covered esophageal stent. It has an efficiency of more than 60% in closing the fistula, and the failure is related to the delayed application of the method, a situation more suitable for endo vac therapy. The most common complication is migration, but life-threatening complications have also been described. The combination of the advantages of endoscopic stents and vacuum therapy is probably found in the emerging VACstent procedure. Conclusions: Although the competing approaches give promising results, this method has a well-defined place in the treatment of esophageal fistulas, and it is probably necessary to refine the indications for each individual procedure. [ABSTRACT FROM AUTHOR]

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Introduction: Safety of pulmonary vein isolation (PVI) has been established in clinical studies. However, despite prevention efforts the incidence of damage to (peri)‐esophageal tissue has not decreased, and the pathophysiology is incompletely understood. Damage to vagal nerve branches may be involved in lesion progression to atrio‐esophageal fistula. Using electrogastrography, we assessed the incidence of periesophageal vagal nerve injury (VNI) following atrial fibrillation ablation and its association with procedural parameters and endoscopic results. Methods: Patients were studied using electrogastrography, endoscopy, and endoscopic ultrasound before and after cryoballoon (CB) or radiofrequency (RF) PVI. The incidence of ablation‐induced neuropathic pattern (indicating VNI) in pre‐ and postprocedural electrogastrography was assessed and correlated with endoscopic results and ablation data. Results: Between February 2021 und January 2022, 85 patients (67 ± 10 years, 53% male) were included, 33 were treated with CB and 52 with RF (38 with moderate power moderate duration [25–30 W] and 14 with high power short duration [50 W]). Ablation‐induced VNI was detected in 27/85 patients independent of the energy form. Patients with VNI more frequently had postprocedural endoscopically detected pathology (8% mucosal esophageal lesions, 36% periesophageal edema, 33% food retention) but there was incomplete overlap. Pre‐existing esophagitis increased the likelihood of VNI. Ablation data and esophageal temperature data did not predict VNI. Conclusion: PVI‐induced VNI is quite common and independent of ablation energy source. VNI is part of (peri)‐esophageal damage and only partially overlaps with endoscopic findings. VNI‐associated acidic reflux may be involved in the complex pathophysiology of esophageal lesion progression to fistula. [ABSTRACT FROM AUTHOR]

An aberrant right subclavian artery (ARSA), also called as arteria lusoria, is one of the most common aortic arch anomalies. ARSA–esophageal fistula is a rare, life-threatening complication, with only 37 cases reported in literature. We describe a case of a young girl who developed acute episode of massive hematemesis after the recovery from novel coronavirus disease 2019 (COVID-19) pneumonia. Computed tomography (CT) angiography showed ARSA with retroesophageal course and active contrast leak in esophagus. Digital subtraction angiography confirmed the site of active contrast extravasation from the ARSA. However, the patient succumbed to hypovolemic shock even before the endovascular or surgical interventions could be done. [ABSTRACT FROM AUTHOR]

An aberrant right subclavian artery (ARSA) is a rare developmental anomaly wherein the right subclavian artery arises from the descending aorta as a fourth branch of the aortic arch. We present the case of ARSA in an 81-year-old woman who was injured in a motorcycle accident. The patient had a history of asymptomatic cerebral infarction, type 2 diabetes mellitus, and rheumatoid arthritis. She was diagnosed with spleen and liver injury, left renal injury, along with fractures in the rib, pelvic, vertebrae, and right tibia. On the 3rd hospitalization day, activated partial thromboplastin time (APTT) prolongation was observed, followed by sudden massive hematemesis and shock on the 39th day. We indicate sudden hematemesis and ARSA bleeding as the cause. We performed compression with a Sengstaken–Blakemore tube and coil embolization for hemostasis. Our findings show that the bleeding was mainly caused by nasogastric tube compression, prolonged APTT, and acquired hemophilia A.

Bronchoesophageal fistulas (BEFs) are rare malformations characterized by abnormal communication between the bronchus and the esophagus. Herein, we report a successful management of a child with BEF discovered as an intraoperative surprise and associated with the short gut, annular pancreas, and disorder of intestinal fixation. [ABSTRACT FROM AUTHOR]

This article discusses a case of Boerhaave syndrome, a rare condition characterized by a spontaneous rupture of the esophagus. The syndrome is typically caused by forceful vomiting and has a high mortality rate. Early detection is crucial for reducing the mortality rate, but the diagnosis is often complicated by other differential diagnoses. Treatment involves surgical intervention and broad-spectrum antibiotics. The article also describes the specific case of a 32-year-old male with Boerhaave syndrome who developed subsequent esophageal stenosis and an esophageal fistula. The patient underwent various procedures and therapies to manage these complications. The article emphasizes the importance of early diagnosis and treatment in reducing mortality and highlights the challenges in diagnosing and managing Boerhaave syndrome. [Extracted from the article]

Boerhaave syndrome is spontaneous rupture of distal esophagus, caused by sharp increase intra esophageal pressure and negative intrathoracic pressure as with sudden forceful vomiting or retching. Classical Mackler clinical triad consists of vomiting, chest pain and subcutaneous emphysema. Mediastinal infection and sepsis are serious complications and can result in mortality upto 30 %, delay in treatment results in significant increase in mortality and morbidity. Early surgery is the best treatment option, surgery in elderly patients with multiple comorbid illness is challenging. Availability of full thickness closure devices using endoscopy like OTSC clips has a role in treating such group of patients. We present a elderly person who presented to us late and successfully managed endoscopically [ABSTRACT FROM AUTHOR]

An aberrant right subclavian artery (ARSA) is a rare developmental anomaly wherein the right subclavian artery arises from the descending aorta as a fourth branch of the aortic arch. We present the case of ARSA in an 81-year-old woman who was injured in a motorcycle accident. The patient had a history of asymptomatic cerebral infarction, type 2 diabetes mellitus, and rheumatoid arthritis. She was diagnosed with spleen and liver injury, left renal injury, along with fractures in the rib, pelvic, vertebrae, and right tibia. On the 3rd hospitalization day, activated partial thromboplastin time (APTT) prolongation was observed, followed by sudden massive hematemesis and shock on the 39th day. We indicate sudden hematemesis and ARSA bleeding as the cause. We performed compression with a Sengstaken–Blakemore tube and coil embolization for hemostasis. Our findings show that the bleeding was mainly caused by nasogastric tube compression, prolonged APTT, and acquired hemophilia A. [ABSTRACT FROM AUTHOR]

Esophagotracheal fistula secondary to esophageal diverticulum is rare but challenging to treat [1]. This case demonstrates that ESD and diverticulum closure by clips can be a valuable procedure for treating chronic esophagotracheal fistula secondary to esophageal diverticulum. [Extracted from the article]

Primary aortoenteric fistulas are rare with an incidence reported up to.07% at autopsy. Literature review yields few reported cases, and rarer still is a fistula between a normal thoracic aorta and the esophagus. Rather, 83% of cases are associated with an aneurysmal aorta and 54% involve the duodenum. Patients with aortoesophageal fistula (AEF) usually present with a triad of chest pain, dysphasia, and a herald bleed. Without treatment, AEFs will result in exsanguination and are universally fatal; even with traditional open surgical treatment, mortality is reported over 55%. The complex pathology of AEFs makes repair more challenging, given an infected field, friable tissue, and patients who are often hemodynamically unstable. Staged repair using endografts as initial treatment with the primary goal of controlling bleeding and preventing fatal exsanguination has been reported. We present a case where a descending thoracic aorta to esophageal fistula was repaired, and this strategy was utilized. [ABSTRACT FROM AUTHOR]

This article, published in Clinical Endoscopy, discusses the closure of an esophageal-pleural fistula using a cardiac occluder in a patient with systemic scleroderma. The patient had previously undergone a thoracotomy and diverticulectomy for a midesophageal diverticulum, but a fistula formed postoperatively. Various methods were attempted to close the fistula, including stents, glue, and surgical sponges, but were unsuccessful. Ultimately, a cardiac occluder was used to successfully close the fistula, and the patient experienced no recurrence three months later. The article suggests that non-standard approaches, such as using a cardiac occluder, may be effective in treating fistulas in patients with systemic scleroderma. [Extracted from the article]

An aortoesophageal fistula is an abnormal communication between the aorta and the esophagus, causing potentially fatal upper gastrointestinal bleeding. The objective of this article is to report a successful case of treatment with a single aortic endovascular approach and conservative treatment of the esophagus in a case of aortoesophageal fistula. An 81-year-old patient was admitted with signs of massive upper gastrointestinal bleeding and, after tests, an aortoesophageal fistula was diagnosed. Endovascular treatment was chosen and performed successfully. The patient was discharged after 9 days in hospital and remained in outpatient follow-up until the condition completely resolved. Early diagnosis is extremely important, since this is a fatal condition if left untreated. It is hoped that this report contributes content of relevance to the scientific community. [ABSTRACT FROM AUTHOR]

Background: The anterior approach to the cervical spine is safe and effective, but not without risks. The pharyngoesophageal perforation (PEP) is a rare but potentially life-threatening complication of this surgical route. A prompt diagnosis and adequate treatment are crucial for the prognosis; nevertheless, there is no unique consent about the best management. Case Description: A 47-year-old woman was referred to our neurosurgical unit for clinical and neuroradiological signs of multilevel cervical spine spondylodiscitis, which was conservatively treated with long-term antibiotic therapy and cervical immobilization after computed tomography-guided biopsy. Nine months later, when the infection was resolved, the patient underwent C3-C6 spinal fusion with anterior plate and screws through anterior approach to the cervical spine for degenerative vertebral changes causing severe myelopathy, and C5-C6 retrolisthesis with instability. Five days after surgical procedure, the patient developed a pharyngoesophagealcutaneous fistula, detected through wound drainage, and confirmed by swallowing contrast study, without systemic signs of infection. The PEP was conservatively treated, with antibiotic therapy and parenteral nutrition, and it was monitored through seriate swallowing contrast and magnetic resonance studies up to the complete resolution. Conclusion: The PEP is a potentially fatal complication of the anterior cervical spine surgery. We suggest an accurate intraoperative control of the pharyngoesophageal's tract integrity at the end of the surgical procedure and a longtime follow-up, because the risk of occurrence is up to several years after surgery. [ABSTRACT FROM AUTHOR]

Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm. [ABSTRACT FROM AUTHOR]

Background: Chromosome 13q deletion syndrome shows variable clinical features related to the different potential breakpoints in chromosome 13q. The severely malformed phenotype is known to be associated with the deletion of a critical region in 13q32. However, esophageal atresia is a rare symptom and the relevant region is unknown. Thus, determining the association between accurate breakpoints and new clinical features is essential. Case presentation: A 28-year-old Japanese primigravid woman was referred for fetal growth restriction, absence of a gastric bubble, cerebellar hypoplasia, overlapping fingers, and polyhydramnios at 31 weeks gestation. At 38 + 0 weeks, she delivered a 1774 g female infant. The infant presented with isolated esophageal atresia (Gross type A), Dandy–Walker malformation, right microphthalmia, left coloboma, overlapping fingers, pleurocentrum in the thoracic vertebrae, reduced anogenital distance, and hearing loss. Her karyotype was diagnosed as 46,XX,del(13)(q32.1–qter) by amniocentesis, but array comparative genomic hybridization after birth revealed the deletion of 13q31.3–qter. At 48 days after birth, the infant underwent surgery for esophageal atresia and was later discharged from the hospital at 7 months of age. Conclusion: This case report and the literature reviews supports the previous findings on the pathological roles of haploinsufficiency of the ZIC2/ZIC5 in Dandy–Walker malformation and the EFBN2 haploinsufficiency in eye malformation and hearing loss. Furthermore, the possible involvement of IRS2, COLA1, and COLA2 in eye malformation were identified. This is the first case of 13q deletion syndrome with esophageal atresia (Gross A), but it may be a symptom of VATER/VACTER association (vertebral defects, anorectal malformations, cardiac defects, tracheoesophageal fistula with or without esophageal atresia, renal malformations, and limb defects), as in the previous cases. These symptoms might also be associated with EFBN2 haploinsufficiency, although further research is required. [ABSTRACT FROM AUTHOR]

Here in we present a 74‐year‐old case of esophago‐pericardial fistula with pericardial effusion and pneumopericardium. Bone‐related esophageal trauma was the cause of the esophago‐pericardial fistula. The esophago‐pericardial fistula was diagnosed with echocardiography, computerized tomography (CT) and endoscopy. Pericardiocentesis was performed for drainage the pericardial effusion. The esophago‐pericardial fistula was treated with covered self‐expandable esophageal stent. [ABSTRACT FROM AUTHOR]

Background and Aim of the Study: An atrioesophageal fistula is a devastating complication of ablation for atrial fibrillation. For the surgeon facing this dreaded complication, it may be a 'once in a lifetime' case. This review aims to describe the clinical problem and evaluate the outcome of different surgical techniques to start guiding cardiothoracic surgeons toward those which offer the best chance of survival. Methods: An electronic search retrieved 125 articles containing 195 cases of atrioesophageal fistula secondary to atrial fibrillation ablation. Reports of pericardio‐esophageal or mediastino‐esophageal fistula were excluded. Results: The median age was 61 and 143 (73%) cases occurred in males. Fever (n = 147; 75%) and neurological dysfunction (n = 151; 77%) were the most common symptoms. The median time from ablation to symptom onset was 21 days (interquartile range: 12–28). The most sensitive thoracic imaging modality was computed tomography (n = 135/153; 90%). Immediate deterioration occurred during 11/58 (19%) oesophago–gastro–duodenoscopies. Mortality was lower in patients who had surgery (39%) compared with endoscopic intervention (94%) or conservative management (97%). Patients who had atrial repair combined with esophageal repair or oesophagectomy were more likely to survive than those who had atrial repair alone (OR 6.97; p <.001). Isolation of the esophageal aspect of the fistula conferred an additional survival benefit (OR 5.85; p =.02). Conclusions: Fever, neurological symptoms, and chest pain in the context of recent ablation should prompt immediate evaluation. Urgent CT thorax should be arranged and repeated if initially unremarkable. Esophageal instrumentation should be avoided due to the risk of catastrophic air embolism or massive hemorrhage. The best way forward is emergency surgical repair; the combination which offers the best survival benefit is atrial repair combined with esophageal surgery and isolation of the esophageal aspect of the fistula. [ABSTRACT FROM AUTHOR]

Malignant tracheo-oesophageal fistula (TEF) can result from tumour progression and invasion of adjacent organs, or a complication of treatment. In the posttreatment setting, incidence of TEF in cases with preceding airway invasion (T4b) are not infrequently reported; however, for those for whom disease was confined to organ (T1–3) at staging, this is a rare complication. Management for these cases is palliative in nature, with the goal to prevent aspiration by closing the connection and facilitate safe resumption of oral intake where possible. Herein we report a case of a 71-year-old female with a T3 oesophageal squamous cell carcinoma, who presented with new onset dysphagia 2 weeks after completing a course of definitive radiotherapy and was found to have a broncho-oesophageal fistula. This patient was managed with dual stenting of both the airway and oesophagus, an emerging management option for this condition, and was thereafter able to safely resume oral intake.

The effectiveness of chemo-immunotherapy for advanced esophageal squamous cell carcinoma (ESCC) remains limited. Therefore, we evaluated the safety and efficacy of radiotherapy plus chemoimmunotherapy as a first-line therapy for advanced ESCC. In this single-arm clinical trial, individuals aged 18–75 years with previously untreated stage IV ESCC received chemotherapy comprising four cycles of 135–175 mg/m2 paclitaxel with carboplatin every three weeks. Toripalimab (240 mg) was intravenously infused every three weeks for 12 months or until disease progression or intolerable toxicity. Radiotherapy commenced in the third cycle, encompassing radiation (50–50.4 Gy in 25–28 fractions) to primary lesions and metastases (30–40 Gy in 3–5 fractions). The primary outcome was progression-free survival (PFS), and secondary outcomes were objective response rate (ORR), disease control rate (DCR), duration of remission (DoR), one- and two-year overall survival rates, and adverse events. Trial Registration: ChiCTR2100046715. From 30 June 2021 to 30 September 2022, we assessed 56 patients for eligibility; among whom, 33 (median age: 59 years, range = 43–74; 29 men) were enrolled. The most common sites for oligometastasis were distant lymph nodes (63.6%), followed by the lungs (15.2%), and bones (9.1%). We observed that 27 (81.8%) patients had a total of 32 oligometastatic lesions, of which 12 were in distant organs and 15 in non-regional lymph nodes, whereas 6 patients (18.2%) had only regional lymph node metastases (cTanyN3M0). Treatment was permanently stopped prior to the commencement of radiotherapy in five patients for the following reasons: informed consent withdrawal (n = 1), supraventricular arrhythmia (n = 1), esophageal fistulae (n = 2), and disease progression (liver metastasis; n = 1). Among the 28 patients who started radiotherapy, one withdrew consent after completing three sessions of radiotherapy, and another refused radiotherapy for liver metastasis after completing radiotherapy for the primary lesion. Ultimately, 26 patients (78.8%) completed the entire radio-chemotherapy course, achieving an ORR, DCR, and DoR of 57.7% (95% CI = 37.3–78.0), 73.1% (95% CI = 54.8–91.3), and 11.5 months (IQR = 6.4–15.0 months), respectively. Within a median follow-up of 22.2 months, the 1-year PFS and OS rate was 50.0% (95% CI = 34–73.4%) and 76.9% (95% CI = 62.3–94.9%), respectively. The median PFS was 12.8 months (95% CI = 8.0 months–not estimable) and the median OS was not attained. Lymphopenia was the most frequent grade ≥ 3 adverse event (82%), and esophageal fistula occurred in three patients (9.1%). No treatment-related deaths occurred. Radiotherapy supplementation to first-line chemo-immunotherapy for treatment-naive advanced ESCC demonstrated substantial antitumor activity and manageable safety, warranting further randomized controlled trials. [ABSTRACT FROM AUTHOR]

This article from the New England Journal of Medicine discusses a case of button-battery ingestion in an 11-month-old girl. The girl presented to the emergency department with symptoms of dysphagia and coughing. A chest radiograph revealed a button battery in the cervical esophagus, and an urgent upper endoscopy was performed to remove it. However, the girl later developed torrential hematemesis and hemorrhagic shock, which was found to be caused by a fistula between the esophagus and the left common carotid artery. Prompt identification and removal of ingested or aspirated button batteries is crucial to prevent tissue necrosis, perforation, and fistula development. The patient was eventually discharged with no neurological or functional deficits. [Extracted from the article]

This article discusses a study conducted in Barcelona on the association between isolated aberrant right subclavian artery (ARSA) and genetic abnormalities in fetuses. The study found that out of 154 fetuses diagnosed with ARSA, 116 were isolated cases and 38 were associated with other structural anomalies. Genetic abnormalities were detected in 4 fetuses, all of which had associated structural defects. However, no genetic disorders or postnatal compressive symptoms were found in the isolated ARSA group. The study concludes that isolated ARSA does not appear to be a risk factor for genetic disorders. [Extracted from the article]

This article discusses the prenatal diagnosis and outcomes of meso/dextrocardia, a cardiac axis abnormality. The study reviewed 29 cases of fetal meso/dextrocardia diagnosed in a single hospital between January 2014 and February 2024. The results showed that there were eight cases of mesocardia and 21 cases of dextrocardia, with different complications associated with each. The study emphasizes the importance of evaluating the entire fetal body for anomalies when meso/dextrocardia is detected. [Extracted from the article]

Abstract Purpose The purpose of the present study was to investigate risk factors for esophageal fistula (EF) in patients with recurrent esophageal cancer receiving re-radiotherapy with or without chemotherapy. Methods We reviewed retrospectively the clinical characters and dosimetric parameters of 96 patients with recurrent esophageal cancer treated with re-radiotherapy in Cancer Hospital Affiliated to Shandong First Medical University between August 2014 and January 2021.Univariate and multivariate logistic regression analyses were provided to determine the risk factors of EF induced by re-radiotherapy. Results The median time interval between two radiotherapy was 23.35 months (range, 4.30 to 238.10 months). EF occurred in 19 patients (19.79%). In univariate analysis, age, T stage, the biologically equivalent dose in the re-radiotherapy, total biologically equivalent dose, hyperfractionated radiotherapy, ulcerative esophageal cancer, the length of tumor and the maximum thickness of tumor had a correlation with the prevalence of EF. In addition, age (HR = 0.170, 95%CI 0.030–0.951, p = 0.044), T stage (HR = 8.369, 95%CI 1.729–40.522, p = 0.008), ulcerative esophageal cancer (HR = 5.810, 95%CI 1.316–25.650, p = 0.020) and the maximum thickness of tumor (HR = 1.314, 95%CI 1.098–1.572, p = 0.003) were risk factors of EF in multivariate logistic regression analysis. Conclusions The incidence of EF was significantly increased in patients with recurrent esophageal cancer who underwent re-radiotherapy. This study revealed that age, T stage, ulcerative esophageal cancer and the maximum thickness of the tumor were risk factors associated with EF. In clinical work, patients with risk factors for EF ought to be highly concerned and individualized treatment plans should be taken to reduce the occurrence of EF.

Abstract Background The current study aimed to comprehensively analyze the clinical prognostic factors of malignant esophageal fistula (MEF). Furthermore, this study sought to establish and validate prognostic nomograms incorporating radiomics and clinical factors to predict overall survival and median survival after fistula for patients with MEF. Methods The records of 76 patients with MEF were retrospectively analyzed. A stepwise Cox proportional hazards regression model was employed to screen independent prognostic factors and develop clinical nomograms. Radiomic features were extracted from prefistula CT images and post fistula CT images. Least absolute shrinkage and selection operator (LASSO) regression and Cox regression algorithm was used to filter radiomic features and avoid overfitting. Radiomic signature was a linear combination of optimal features and corresponding coefficients. The joint prognostic nomograms was constructed by radiomic signatures and clinical features. All models were validated by Harrell's concordance index (C‐index), caliberation and bootstrap validation. Results For overall survival, age, prealbumin, KPS and interval between diagnosis of esophageal cancer and fistula were identified as independent prognostic factors and incorporated into the clinical nomogram. Age, prealbumin, serum albumin, KPS and neutrophil proportion were selected for the clinical nomogram of post fistula survival. The C‐index of overall survival nomogram was 0.719 (95% CI: 0.645–0.793) and that was 0.722 (95% CI: 0.653–0.791) in the post fistula survival nomogram. The radiomic signature developed by radiomic features of prefistula CT showed a significant correlation with both overall survival and post fistula survival. The C‐index of joint nomogarm for overall survival and post fistula survival was 0.831 (95% CI: 0.757–0.905) and 0.77 (95% CI: 0.686–0.854), respectively. The calibration curve showed the joint nomograms outperformed the clinical ones. Conclusions The study presents nomograms incorporating independent clinical risk factors and radiomic signature to predict the prognosis of MEF. This prognostic classification system has the potential to guide therapeutic decisions for patients with malignant esophageal fistulas.

The key finding is that in this sizeable dataset of AF ablation procedures, only 138 patients were diagnosed with an AOF, equating to a 0.025% incidence post-ablation. The strength of this observation is confounded by the fact that 45.5% of patients who underwent RF ablation received linear ablation in addition to pulmonary vein isolation (PVI) whereas the cryoablation group received PVI alone. [Extracted from the article]