Minimally Invasive Treatment Strategies for Tracheoesophageal Fistulae

Abstract

Tracheoesophageal fistula (TOF) is a serious consequence of invasive malignancy or iatrogenic injury. TOF can result in aspiration, infection, and sepsis causing significant morbidly and mortality. Management of TOF is challenging and deciding an appropriate strategy requires a multidisciplinary approach. Surgical management has limited application with associated risks and is not an option for a large portion of patients. Minimally invasive methods such as endoscopic repair and stent insertion are favorable. Radiological insertion of metallic stents allows accurate stent placement with the aid of fluoroscopic mapping. This review describes the various methods of managing TOF by a multidisciplinary team.

Best Practices in Esophageal, Gastroduodenal, and Colonic Stenting

“…Combined placement of stents in both the esophagus and the tracheobronchial tree is another management strategy for esophago-respiratory fistulas (ERF), being indicated if esophageal stenting could compromise the respiratory tract via extrinsic compression (more likely in mid-/proximal ERF); if there is a pre-existing tracheal stenosis; and in cases of large fistulas (>20 mm) [ 39 , 40 , 41 ]. However, patients who require dual esophageal and airway stenting are at risk for fistula worsening due to pressure necrosis on both sides of the fistula from the two opposing stents [ 42 ].…”

Oesophageal stenting: Status quo and future challenges

“…[53][54][55] Fistula formation Fully covered stents are used to treat oesophageal fistulae of either malignant or benign origin. 56 However very infrequently, stents can themselves fistulateusually into the respiratory tract. Tracheo-oesophageal fistula (TOF) formation as a consequence of stent placement is an uncommon but life-threatening complication and has been reported in 3-5% of cases.…”