Case report: Endoscopic closure with double stenting and autologous fascia lata graft of large tracheo-esophageal fistula

Mattioli, Francesco; Serafini, Edoardo; Andreani, Alessandro; Cappiello, Gaia; Marchioni, Daniele; Pinelli, Massimo; Tonelli, Roberto; Clini, Enrico; Marchioni, Alessandro

doi:10.3389/fsurg.2023.1107461

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…Currently, endoscopic intervention has been considered as the most effective method for palliation of malignant ERF ( 6 ). There are several research reported on the endoscopic treatment of malignant ERF, including airway stents, esophageal stents, double stents, and autologous tissue ( 15 , 16 ). European Society of Gastrointestinal Endoscopy (ESGE) Guideline recommends the application of double stenting (esophagus and airway) when fistula occlusion is not achieved by esophageal or airway prosthesis placement alone ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Palliation of malignant esophageal stent esophagorespiratory fistula with rigid bronchoscope and Y silicone trachea stent: experience with seven patients

Wang,

Chen,

et al. 2024

J Thorac Dis

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Background Malignant esophageal stent esophagorespiratory fistula (ERF) is an abnormal communication between esophagus and airway among advanced tumor patients with indwelling esophageal stent, which is devastating and life-threatening. This study aims to provide a new feasible treatment scheme for malignant esophageal stent ERF and report its potential advantage compared with double stenting, which was recommended by European Society of Gastrointestinal Endoscopy Guideline. Methods We retrospectively analyzed the medical data of malignant esophageal stent ERF patients between January 2018 to May 2023 at the First Affiliated Hospital of Guangzhou Medical University and divided them into two groups. Group 1 consisted of patients treated with rigid bronchoscopy to remove the esophageal stent and implant Y silicone trachea stent, while group 2 consisted of patients treated with additional airway stenting without removing the esophageal stent. Demographic parameters, disease diagnoses and treatment, radiological findings before and after the intervention, and complications caused by the stents were obtained and analyzed with chi-squared, Mann-Whitney U , independent-samples t -tests, Kaplan-Meier methods, and log-rank test. Results Ten patients (seven patients in group 1 and three in group 2) were included. No procedure complications occurred in both groups. The mean Karnofsky Performance Score after the procedure significantly improved compared to the pre-procedure (57.14 vs. 77.14, P=0.001) in group 1, while decreased in group 2 (50 vs. 40, P=0.026). The control of pneumonia in group 1 patients is better than that in group 2. There was significant improvement in the degree of dysphagia after the procedure (3.86 vs. 2.43, P=0.002) in group 1, while no improvement was found in group 2 (4.00 vs. 3.33, P=0.423). The mean survival of group 1 was significantly longer group 2 (381.00 vs. 80.33 days, P<0.001, log-rank test). No patient needed stent repositioning due to migration in both groups. Cause of death in the group 1 included disease progression, novel coronavirus pneumonia, massive hemoptysis, and respiratory insufficiency, while group 2 included severe pneumonia and disease progression. No death was directly attributed to the procedure in both groups. Conclusions Removing the esophageal stent and implanting Y silicone trachea stent through a rigid bronchoscopy is a safe and feasible treatment for malignant esophageal stent ERF. This procedure can effectively seal the fistula, prevent from recurrent aspiration pneumonia, improve the quality of life, and prolong the survival time.

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Section: Discussionmentioning

confidence: 99%

Palliation of malignant esophageal stent esophagorespiratory fistula with rigid bronchoscope and Y silicone trachea stent: experience with seven patients

Wang,

Chen,

et al. 2024

J Thorac Dis

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Efficacy and risk factors of stent placement in the treatment of malignant tracheoesophageal fistula

Wang,

Duan,

Liu

et al. 2024

Front. Oncol.

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BackgroundDue to the low incidence of malignant tracheoesophageal fistula and the paucity of relevant clinical studies, the benefits of stent implantation have not been well documented. It remains unclear which factors may affect fistula closure.MethodsBetween January 2015 and January 2021, 344 patients who were diagnosed with malignant tracheoesophageal fistula at Zhongda Hospital, Southeast University, were retrospectively enrolled. Demographic and clinical data were collected. Risk factors for fistula closure identified by univariate analysis were further analyzed using multivariable logistic regression.ResultsA total of 288 patients were analyzed in this study, of which 94 were treated conservatively, 170 were treated with an esophageal stent, and 24 were treated with a tracheal stent. Among them, the delta Karnofsky’s performance status score values (after 2 weeks/before treatment [p = 0.0028], after 1 month/before treatment [p = 0.0103]) were significantly different between conservative and stent treatment. There was a significant reduction of pneumonia incidence in the stenting group (33.53%) compared to the conservative treatment group (77.05%) after one month (p <0.0001). In addition, the closure of fistulas was influenced by four independent risk factors: 1) treatment methods (p < 0.0001), 2) fistula size (p = 0.0003), 3) preoperative white blood cell count (p = 0.0042), and 4) preoperative Karnofsky’s performance status score (p = 0.0001).ConclusionsStent implantation has become an effective method for treating malignant tracheoesophageal fistula compared to conservative treatment. Additionally, stent implantation, smaller fistula size, lower preoperative white blood cell count, and higher preoperative Karnofsky’s performance status score suggest a better outcome.

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Case report: Endoscopic closure with double stenting and autologous fascia lata graft of large tracheo-esophageal fistula

Cited by 2 publications

References 12 publications

Palliation of malignant esophageal stent esophagorespiratory fistula with rigid bronchoscope and Y silicone trachea stent: experience with seven patients

Palliation of malignant esophageal stent esophagorespiratory fistula with rigid bronchoscope and Y silicone trachea stent: experience with seven patients

Efficacy and risk factors of stent placement in the treatment of malignant tracheoesophageal fistula

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