TOF and endoscopic Occluders(Endoscopy, Jan-2026)

Tracheoesophageal fistulas (TOF) or gastrointestinal (GI)–tracheobronchial fistulas are abnormal connections between the trachea and the esophagus or GI tract. These conditions are often challenging to manage, especially when refractory to conventional treatments. Endoscopic occluders represent a minimally invasive therapeutic option for such fistulas, and recent studies have compared the efficacy and safety of different occluder designs.

For example, in a retrospective cohort study, two novel occluders were evaluated: the double umbrella-shaped (DU) occluder and the mushroom umbrella-shaped (MU) occluder. The MU occluder demonstrated superior outcomes in terms of sustained occlusion, with a 12-month cumulative sustained occlusion probability of 82.1% compared to 65.5% for the DU occluder. Additionally, the MU occluder had fewer complications, such as esophageal wall injuries, which were observed in the DU group. Both occluders achieved 100% technical success rates, and adverse events were mild in both groups.

The results suggest that the MU occluder may be a more effective and safer option for managing refractory GI–tracheobronchial fistulas. However, further prospective studies are necessary to validate these findings and optimize treatment protocols.