The Unexpected Formation of a Broncho-Esophageal Fistula of the Right Main Stem Bronchus Status Post Esophageal Stent Placement: A Case Report

Abstract

This case presents a patient with a history of non-small cell lung carcinoma who had radiation therapy complicated by esophageal dysphagia. She had a fully covered self-expanding metal stent (SEMS) placed one year ago in the proximal region of her esophagus prior to this admission. She presented to the emergency department (ED) for dyspnea on exertion. Imaging showed a persistent right lower lobe opacity, and bronchoscopy revealed a right broncho-esophageal fistula (BEF). Further investigation by endoscopy found that the fully covered SEMS migrated distally and caused the formation of her fistula. This case presents a patient with a right BEF caused by a migrating esophageal stent.

A Successful Treatment of Broncho-Esophageal Fistula with Esophageal Stenting Using Direct Endoscopic Visualization

“…As reported by Patel et. al., in the case of a patient with non-small cell lung carcinoma, the fully covered SEMS placed to improve esophageal dysphagia migrated distally and led to the formation of a BEF [33]. In this case, the fully covered stent was replaced with a partially covered one, while a gastrostomy/jejunostomy tube was placed to facilitate feeding [33].…”

“…Patel et al reported the formation of BEF as a delayed complication of a fully covered SEMS insertion. The patient, diagnosed with non-small cell lung carcinoma, had a SEMS placed in the proximal region of her esophagus to alleviate the esophageal dysphagia that occurred as a result of radiation therapy [33]. After 1 year post insertion, the fully covered SEMS migrated distally and caused the formation of her BEF; the fully covered SEMS was replaced with a partially covered SEMS that led to the resolution of the fistulous tract [33].…”

“…The patient, diagnosed with non-small cell lung carcinoma, had a SEMS placed in the proximal region of her esophagus to alleviate the esophageal dysphagia that occurred as a result of radiation therapy [33]. After 1 year post insertion, the fully covered SEMS migrated distally and caused the formation of her BEF; the fully covered SEMS was replaced with a partially covered SEMS that led to the resolution of the fistulous tract [33]. Even though the early complications after SEMS insertion are rare, delayed complications have been reported in up to 63% of cases [34].…”