Successful endoscopical sealing of malignant esophageotracheal fistulae by using a covered self-expandable stenting system

Abstract

In spite of the small number of patients the results suggest that this type of stent represents a safe and efficient approach for palliative endoscopic treatment of this high risk group. Local pretreatment does not preclude the successful use of the self-expandable coated stent.

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

“…Direct surgical fistula closure, bypass or fistula resection do not yield good results, and endoscopic stenting or endoprosthesis are palliative options in this situation [1]. Stents can be placed bronchoscopically in the airways, via EGD in the oesophagus or both in the airways and oesophagus to seal the defect and restore the patency of the passages with resumption of oral feeds [2][3][4][5].…”

Temporary stenting of acquired benign tracheoesophageal fistulas in critically ill ventilated patients

“…For the Wilson-Cook stent it is somewhat obvious, since it is designed for such a use, i.e., the foamed, air-filled balloon to invade and seal the fistula. For the Ultraflex, although it is not specially designed for such use, its rapid expansion caused tight fixation to the esophageal wall and sealing of the TEF at a rate of 73% to 100%, according to different series [1,12,19,27,30], referring both to malignant and benign fistulas.…”

Management of a difficult malignant tracheoesophageal fistula

“…Tissue glues and amino acid solutions have been instilled in small fistula with some success [6] but they can cause obstruction of the respiratory tree due to their sealing effect [6]. Conventional oesophageal prostheses are suitable for tracheoesphageal fistula with a stenotic tumour but often migrate and allow food to track into the fistula in a normal sized oesophagus [1,3]. Covered self-expanding stents have been used to successfully treat malignant tracheoesophageal fistula [7] but may prove to be unsuccessful in a dilated oesophagus as in our case.…”

“…The frequency of this complication in patients with oesophageal cancer ranges from 5 to 10% [1,2]. They are associated with a dramatic downhill course leading to continued respiratory tract contamination, sepsis and death [1 -3].…”

“…Per oral placement of an oesophageal stent is often used to close the fistula to prevent respiratory infection and to allow oral feeding [1 -3]. Problems have been reported with tube migration in dilated oesophagus along with other complications including tube induced perforation and necrosis [1,2]. We report a case in which a covered selfexpanding oesophageal prosthesis failed to obliterate a tracheoesophageal fistula or even was contributory towards it and use of a cuffed Wilson -Cook prosthesis established successful palliation.…”