Exploring the Landscape of Esophageal Discontinuity Procedures and Cervical Esophagostomy in the Modern Era: A Scoping Review

Background: Esophageal discontinuity remains a significant challenge. However, the literature lacks a comprehensive understanding of the indications for esophageal discontinuity, strategies for reversal, and long-term outcomes. This scoping review characterizes the existing evidence, identifies knowledge gaps and provides practical considerations. Methods: Following Arksey and O’Malley frameworks, we searched MEDLINE, EMBASE, and CENTRAL for studies from 1990 to 2023 involving patients who received a cervical esophagostomy for gastrointestinal discontinuity. Grey literature, editorials, protocols, and non-English studies were excluded. Two authors independently screened titles, abstracts, and full texts. Results: Of the 231 studies included, 150 (65%) were case reports, 62 (26.5%) were single-institutional observational studies, 10 (4.3%) were reviews, with few other study designs. Most studies (68%) were in the adult population. The most common geographical region was East Asia (32%), followed by North America and Western Europe (both 24.2%). The most common indications were perforation (29%), stricture/fistula (21.6%) and atresia (18.6%), with notable regional variation. Only 24.2% of studies occurred in the oncologic setting and 24.2% of studies did not report whether reversal was considered. Among 1884 patients with esophageal discontinuity, the overall reversal rate was 79.8%; excluding atresia cases, the rate was 73.2%. Conclusion: There are critical gaps in the literature, including a lack of multi-institutional studies, limited descriptions of reversal procedures, lack of measurement of nutritional and functional outcomes and few clinical trials. Greater international collaboration is needed to develop a longitudinal registry and define long-term quality outcomes for this complex rare disease entity which could be known as foregut failure .