Treatment of an Esophagorespiratory Fistula by Insertion of an Esophageal Montgomery and Tracheal Dynamic Stent after Failure of Conventional Endoprosthesis

Abstract

Esophagorespiratory fistulae at the adult age can develop through malignant tumor growth, endoscopy, bougienage, laser therapy, or through a radiochemotherapy. We report a female patient with inoperable bronchial cancer, who developed a symptomatic esophagorespiratory fistula during radiochemotherapy with cisplatin. At first, conventional plastic tubes and then novel selfexpanding silicone-coated Gianturco-Song stents were used in an unsuccessful attempt to close the fistula. After the extraction of two Gianturco-Song stents, the insertion of a Montgomery-Salivary bypass stent in the esophagus and a dynamic stent in the trachea resulted in a permanent occlusion of the fistula. This case demonstrates that Montgomery-Salivary bypass stents do not tend to migrate due to their characteristic shape and self-fixation, and that the novel self-expanding, silicone coated Gianturco-Song stents can be extracted with rigid endoscopy if necessary.

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

“…No major technical difficulties were experienced, supporting the hypothesis that airway and/or oesophageal stent insertion have an important role in the palliation of malignant AEF. Earlier studies have proposed combined airway and oesophageal stenting for malignant AEF [21][22][23]. The current study was not designed to examine the benefits of combined oesophageal and airway stenting compared to airway or oesophageal stenting in patients with malignant AEF.…”

Palliation of malignant aerodigestive fistulae with self-expanding metallic stents

“…The first successful application of SEMS to treat MADFs was by Song et al ., using modified Gianturco stents (Cook Europe, Denmark) 2,8 . The feasibility of this strategy was later confirmed by others using Montgomery and Dumon silicone stents 1,3 . The clinical success achieved by the early SEMs was accompanied by a concomitant decrease in the rate of post‐procedure complications.…”

“…2,8 The feasibility of this strategy was later confirmed by others using Montgomery and Dumon silicone stents. 1,3 The clinical success achieved by the early SEMs was accompanied by a concomitant decrease in the rate of post-procedure complications. Surgical therapies aimed at MADF were accompanied by a prohibitive mortality (29-40%) but SEMS decreased the morbidity rate to 0-6.3% during this early experience.…”

“…Endoluminal approaches have proven useful for these patients. [1][2][3][4][5][6][7][8][9] We report our experience in the management of MADF using self-expandable metallic stents (SEMS).…”