{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:11:58Z","timestamp":1784045518819,"version":"3.55.0"},"reference-count":30,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestion"],"abstract":"<jats:p>Introduction: 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. Methods: 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. Results: Univariate and multivariate COX regression analyses revealed that endoscopic closure could significantly improve short-term pulmonary infections based on CPIS gap (3 vs. 2; p = 0.004) but did not influence survival or fistula healing outcomes, and the hospitalization costs were elevated (USD 6,653 vs. USD 3,350; 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\u20130.984, p = 0.012), absence of bloodstream infections (positive blood culture [HR = 23.055, 95% CI: 5.193\u2013102.357, p &lt; 0.001]), non-T4 stage (T4 stage [HR = 1.792, 95% CI: 1.052\u20133.052, p = 0.032]), and no distant metastasis (distant metastasis [HR = 2.122, 95% CI: 1.127\u20133.996, p = 0.020]). Cervical esophageal fistula (upper [HR = 0.154, 95% CI: 0.041\u20130.570, p = 0.005]; middle [HR = 0.128, 95% CI: 0.027\u20130.609, p = 0.010]; lower [HR = 0.218, 95% CI: 0.052\u20130.902, p = 0.036]) was significantly associated with improved fistula healing outcomes, while a history of radiotherapy (HR = 0.265, 95% CI: 0.089\u20130.788, p = 0.017) was a risk factor for esophageal fistula healing. Conclusion: 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 does not significantly enhance long-term healing or survival prognosis.<\/jats:p>","DOI":"10.1159\/000547231","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T16:02:39Z","timestamp":1753113759000},"page":"299-308","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Endoscopic Closure Treatment on Outcomes in Patients with Esophageal Cancer-Associated Fistula: A Retrospective Analysis"],"prefix":"10.1159","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7583-7196","authenticated-orcid":false,"given":"Qijie","family":"Dai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xian","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weipeng","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yitian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiepeng","family":"Cen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heqing","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.20892\/j.issn.2095-3941.2016.0093"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21820"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/jso.22092"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.10.028"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.7150\/jca.39033"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-67859-0"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.02.031"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-019-1385-y"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0b013e3182618948"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0042766"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1042\/BSR20193379"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.02.025"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.04.125"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000125"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.562147"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/den.12025"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1186\/s40644-022-00490-2"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/143.5_Pt_1.1121"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.08.023"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0094-2020"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2017-0646"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2017.09.020"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1421020"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.2147\/OTT.S161803"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-018-4486-3"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1093\/jrr\/rru031"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.DMIH2-0004-2015"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-2050.2009.00950.x"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-069703"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2012.10.004"}],"container-title":["Digestion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000547231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:01:38Z","timestamp":1784044898000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000547231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,7,14]]},"published-print":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1159\/000547231","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.29581853","asserted-by":"subject"}]},"ISSN":["0012-2823","1421-9867"],"issn-type":[{"value":"0012-2823","type":"print"},{"value":"1421-9867","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]}}}