The mainstay of treatment is pleural and mediastinal debridement combined with esophageal repair and spillage prevention (24). Esophageal wall closure may be achieved via primary suture with patch reinforcement or over a T-tube drainage to create a controlled esophagocutaneous fistula.

Endoscopic treatments have been proposed in selected patients with early diagnosis, no sepsis, and good tolerance to pleural contamination. Self-expandable stents, closing with OTSC or other clipping devices, vacuum therapy, Apollo Overstitch, through-the-scope fistula lavage, local antibiotics instillation, and naso-collection or double pig-tail internal drains have been reported with different success rates and related-complications (27-30.

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