Combined airway and oesophageal stenting in malignant airway-oesophageal fistulas: a prospective study

Abstract

Malignant airway-oesophageal fistulas (AEF) are a serious complication of advance oesophageal or lung cancer.The aim of this study was to assess the quality of life before and after stent insertion, and to examine the role of treatment and location of AEF as factors influencing survival in AEF patients managed with airway and/or oesophageal stent insertion.112 patients with AEF were included prospectively. 83 (74%) patients had advanced lung cancer and 29 (26%) patients had oesophageal cancers.Airway stents were inserted in 65 (58%) patients, oesophageal stents in 37 (33%) patients, and both airway and oesophageal stents in 10 (9%) patients. Seven (6%) patients developed respiratory failure and required transient ventilator support in the intensive care unit (four patients with airway stenting, two patients with double stents and one patient in the oesophageal stenting group). None of the patients developed stent migration or needed stent repositioning. Overall, mean survival was 236.6 days (airway stent 219.1 days, oesophageal stent 262.8 days and combined airway-oesophageal stent 252.9 days). Backward, stepwise regression revealed the site of stent placement (airway and/or oesophagus; p,0.028), exact location of the fistula in airway (p50.011) and additional treatment with chemotherapy and/or radiation (p,0.001) as independent risk factors predicting increased survival. The mean quality of life score (QoL) was 81 prior to stent insertion and 72 post-stent insertion (p,0.001).Airway and/or oesophageal stent insertion provides an effective approach to improve the QoL in patients with malignant AEF.

Self-Expandable Metallic Stents in Oesophago-Respiratory Fistulas Treatment in Neoplasms—Case Reports and Literature Review

“…The average quality of life (QoL) score before stents implantation was 72, and after the procedure it amounted to 81. The difference was statistically significant [14].…”

“…SEMS insertion effectively closes fistulas in 88.9-96% of patients [4, 6, 9−12]. In selected cases, endoscopic double stenting (airway and esophageal) is performed [13,14]. However, SEMS implantation could lead to complications, which occur in 10−30% of cases [4,7,12].…”

Metallic stents in the airway: should we continue to use them and can we remove them?

“…In a study by Herth, airway, and in the majority of cases esophageal, stenting using self-expanding nitinol stents was performed in 112 patients with malignant tracheoesophageal fistulas. Stenting resulted in improvement of quality of life scores, and the overall mean survival in the study population was 236.6 days [22].…”

“…Esophageal stenting may cause secondary airway compromise by extrinsic compression when the stent is fully deployed. Airway stenting with or without esophageal stenting has been performed successfully in cases of malignant tracheoesophageal fistulas; it has been shown to improve symptoms and quality of life [22,23]. In a study by Herth, airway, and in the majority of cases esophageal, stenting using self-expanding nitinol stents was performed in 112 patients with malignant tracheoesophageal fistulas.…”

Closure of Nonmalignant Tracheoesophageal Fistula Using an Atrial Septal Defect Occluder: Case Report and Review of the Literature

“…Most tracheoesophageal fistulas (TEFs) are malignant and often result from tumor growth or recurrence in esophageal and lung carcinomas [1,2]. Nonmalignant TEF is rare, and causes can include congenital dysplasia, complication of surgery or sent placement, trauma, infection, and long-term intubation [3][4][5][6][7][8][9][10].…”