Erosion of esophageal stent into left main bronchus causing airway compromise

Background: Tracheobronchial stenting either alone or with esophageal stenting is often required for symptom palliation in obstructive or fistulous lesions of the airway due to esophageal cancer. There is limited evidence regarding dual stenting for lesions near the carina due to esophageal cancer. Hence, this study aims to evaluate the technical feasibility, outcomes, and complications of preplanned dual stenting in these patients. Methods: This is a prospective observational study carried out over a period of 4 years (January 2015 to July 2019). All patients undergoing dual stenting in the airway and esophagus with obstructive or fistulous lesions near the carina were included. The esophageal stent was placed within 24 hours. Prestenting and poststenting symptoms were compared using a symptom-based visual analog scale, Hugh Jones dyspnea scale and dysphagia scale. Results: Twenty-nine patients (20 males; mean±SD age, 55.3±12.2 y) underwent dual stenting. Twenty-four patients had central airway obstruction due to: infiltration in 20 (69%) and external compression in 4 (13.7%), respectively. Five (17.3%) patients had tracheoesophageal fistula with no airway obstruction. In 80% of the patients (n=23), silicone stents were placed. There was significant improvement in both dyspnea and dysphagia after dual stenting (P<0.001). Mucus plugging, lower respiratory infection, and granulation tissue were the main complications. Median survival after dual stent was 97 days (range, 17 to 297 d). Conclusion: Dual stenting within the airway and the esophagus is a safe and viable option for palliative relief of symptoms in patients with advanced esophageal cancer.

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Dual Airway and Esophageal Stenting in Advanced Esophageal Cancer With Lesions Near Carina

Khan

Hashim

Neyaz³

et al. 2020

Journal of Bronchology &Amp; Interventional Pulmonology

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Acquired benign tracheo‑oesophageal fistula secondary to oesophageal stenting for post lye ingestion stenosis: A case report

et al. 2022

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Acquired benign trachea-oesophageal fistula is a rare benign pathological entity with varying aetiologies that most often occurs post-intubation. This case report presents the case of a female patient, 31 years old, admitted to the emergency room with sepsis syndrome following bilateral aspiration pneumonia caused by a large trachea-oesophageal fistula. The fistula was the result of intra-tracheal migration of an oesophageal stent placed for post lye ingestion stenosis. Esophageal diversion and partial resection with oesophageal patch to repair the tracheal defect, under general anaesthesia with ventilation using rigid bronchoscopy and high frequency jet ventilation (HFJV), followed at a later date by esophageal replacement with colic graft were the procedures performed with a view to curing the patient. In conclusion, complex cases always require a tailored approach. It is important to note that HFJV may be applied for a longer period of time and the oesophagus can be used as patch for the posterior tracheal wall in selected cases. Staged surgery is also an option when the patients' poor health status does not permit major surgery.

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Aorto-oesophageal fistula after corrosive ingestion: A case report

Scriba¹,

Kotze²,

Naidoo³

et al. 2022

WJGS

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BACKGROUND Aorto-oesophageal fistula (AOF) are uncommon and exceedingly rare after corrosive ingestion. The authors report a case of AOF after corrosive ingestion that survived. A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition, how it is best managed and what the outcomes are. CASE SUMMARY A previously healthy 30-year-old male, presented with a corrosive oesophageal injury after drain cleaner ingestion. He did not require acute surgical resection, but developed long-segment oesophageal stricturing, which was initially managed with cautious dilatation and later stenting. An AOF was suspected at endoscopy performed two months after the ingestion, when the patient represented with massive upper gastrointestinal bleeding. The fistula was confirmed on computerised tomographic angiography. The initial bleeding at endoscopy was temporised by oesophageal stenting; a second stent was placed when bleeding recurred later the same day. The stenting successfully achieved temporary bleeding control, but resulted in sudden respiratory distress, which was found to be due to left main bronchus compression caused by the overlapping oesophageal stents. Definitive bleeding control was achieved by endovascular aortic stent-grafting. A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft sepsis. He was subsequently successfully discharged and remains well one year post injury. CONCLUSION AOF after corrosive ingestion is exceedingly rare, with a very high mortality. Most occur weeks to months after the initial corrosive ingestion. Conservative management is ill-advised.

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Erosion of esophageal stent into left main bronchus causing airway compromise

Cited by 3 publications

References 14 publications

Dual Airway and Esophageal Stenting in Advanced Esophageal Cancer With Lesions Near Carina

Dual Airway and Esophageal Stenting in Advanced Esophageal Cancer With Lesions Near Carina

Acquired benign tracheo‑oesophageal fistula secondary to oesophageal stenting for post lye ingestion stenosis: A case report

Aorto-oesophageal fistula after corrosive ingestion: A case report

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