Endoscopic management of refractory gastrointestinal–tracheobronchial fistulas with two novel occluders: a comparative cohort study

Abstract

Background

Refractory gastrointestinal (GI)–tracheobronchial fistulas are challenging to manage. This study compared the outcomes of two novel occluders specifically designed for endoscopic occlusion of GI–tracheobronchial fistulas.

Methods

In this retrospective cohort study, 86 patients with refractory GI–tracheobronchial fistulas who underwent endoscopic occlusion using either a double umbrella-shaped (DU; n = 36) or mushroom umbrella-shaped (MU; n = 50) occluder were included. The primary outcome was sustained occlusion. Secondary outcomes included technical success, adverse events (AEs), occluder-related discomfort, and percentage weight gain.

Results

The DU occluder was associated with a higher risk of occlusion failure compared with the MU occluder (hazard ratio [HR] 2.67, 95%CI 1.24–5.73; P = 0.01), with a 12-month cumulative sustained occlusion probability of 65.5% (95%CI 51.3%–83.5%) versus 82.1% (95%CI 71.4%–94.3%), respectively. Esophageal wall injury requiring occluder removal occurred in six DU patients, but in none of the MU group. Technical success was 100% in both groups. All procedure-related AEs were mild, occurring in five DU (13.9%) and three MU patients (6.0%).

Conclusions

The MU occluder showed greater potential for sustained occlusion than the DU occluder and may be a viable option for refractory GI–tracheobronchial fistulas, although further prospective studies are needed.

Publication History

Received: 25 February 2025

Accepted after revision: 18 July 2025

Article published online:
19 August 2025

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