Oesophageal stent-associated esophagorespiratory fistula

Madan, Karan; Venuthurimilli, Arun; Guleria, Randeep

doi:10.1136/bcr-2015-211880

Cited by 4 publications

(4 citation statements)

References 2 publications

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“…However, whether the treatment for malignant ERF is entirely suitable for malignant esophageal stent ERF remains uncertain ( 8 ). Madan et al reported a case of malignant esophageal stent ERF, in which they used a covered tracheal SEMS to seal the ERF through a rigid bronchoscopy ( 7 ). This case demonstrated the feasibility of double stenting in the treatment of malignant ERF with indwelling esophageal stent, but the long-term benefit of the patients is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, endoscopic treatment is regarded as the preferred option for the management of malignant esophageal stent ERF ( 6 ). However, the reported endoscopic treatment methods for malignant esophageal stent ERF are basically based on the treatment for ERF, such as additional esophageal and/or tracheal stents, which may increase pressure on the affected tissue, ultimately creating a larger fistula ( 2 , 7 - 9 ).…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…[9] Bronchoscopic approach to the placement of covered tracheal/bronchial SEMS placement may include either rigid or flexible bronchoscopy; however, rigid bronchoscopy is the preferred modality in situations with significant airway compromise. [101112]…”

Section: Discussionmentioning

confidence: 99%

“…[1415] Although late complications after 8 months have been mentioned in literatures, in our case the complication has occurred 3 years after insertion of the stent. [11] To the best of our knowledge, such a delayed complication has not yet been reported in the literature. Moreover, TOF is common to occur, whereas esophagobronchial fistulas are very rare as in our case.…”

Section: Discussionmentioning

confidence: 99%

Erosion of esophageal stent into left main bronchus causing airway compromise

et al. 2017

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Covered or uncovered self-expanding metal stents are currently used for the palliative treatment of neoplastic esophageal strictures or compressions and esophageal leaks or fistulas due to malignancies. Erosion of esophageal stents into the respiratory tract is a rare complication and that too has been reported mostly as an early complication within few days or weeks. Here, we present the case of a 31-year-old female, who presented with a late complication of an esophageal stent eroding into the left main bronchus causing respiratory distress. She was stented for a benign corrosive esophageal stricture following caustic soda ingestion 3 years ago. She underwent a thoracotomy and closure of esophagobronchial fistula along with laparoscopic esophagectomy and gastric pull through. Postoperatively, patient developed an anastomotic leak which was corrected by placing a temporary stent.

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