Application of combined-type Y-shaped covered metallic stents for the treatment of gastrotracheal fistulas and gastrobronchial fistulas

Li, Teng-Fei; Duan, Xuhua; Han, Xinwei; Wu, Gang; Ren, Jianzhuang; Lü, Hao

doi:10.1016/j.jtcvs.2016.03.090

Cited by 23 publications

(16 citation statements)

References 26 publications

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“…Surgery also has fewer complications because of the lack of devices left in the body, while device placement can lead to massive bleeding, hemoptysis, asphyxia, and death. [16][17][18] Notably, surgery can be performed if non-surgical treatment fails, if the patient's general condition is suitable. 8,9 The median survival duration was significantly higher among patients who underwent surgical repair compared with those who received tracheal stents.…”

Section: Discussionmentioning

confidence: 99%

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Wang

Chen

et al. 2020

J Int Med Res

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Background Thoracogastric airway fistula (TGAF) is a serious complication of esophagectomy for esophageal cancer. We conducted a systematic review of the appropriate therapeutic options for acquired TGAF. Methods We performed a literature search to identify relevant studies from PubMed, EMBASE, and Web of Science using the search terms “gastric airway fistula”, “gastrotracheal fistula”, “gastrobronchial fistula”, “tracheogastric fistula”, “bronchogastric fistula”, “esophageal cancer”, and “esophagectomy”. Result Twenty-four studies (89 patients) were selected for analysis. Cough was the main clinical presentation of TGAF. The main bronchus was the most common place for fistulas (53/89), and 29 fistulas occurred in the trachea. Almost 73% (65/89) of patients underwent non-surgical treatment of whom 87.7% (57/65) received initial fistula closure. Twenty-three patients underwent surgery, including 19 (82.6%) with initial closure. The 1-, 2-, 3-, 6-, and 9-month survival rates in patients who underwent surgical repair were 95.65%, 95.65%, 82.61%, 72.73%, and 38.10%, respectively, and the equivalent survival rates in patients with tracheal stent placement were 91.67%, 86.67%, 71.67%, 36.96%, and 13.33%, respectively. Conclusion TGAF should be suspected in patients with persistent cough, especially in a recumbent position or associated with food intake. Individualized treatment should be emphasized based on the general condition of each patient.

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Section: Discussionmentioning

confidence: 99%

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Wang

Chen

et al. 2020

J Int Med Res

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“…Two case series published in 2006 and 2008 have demonstrated good feasibility and high success rates. Overall, to date, 12 case series (including 370 patients) describing the use of tracheobronchial SEMS have been published, with similar success rates, efficacy and median survival as the silicone stents 6,19,28–37 . A review of the insertion technique shows that despite the Y SEMS advantage, not requiring the use of a rigid bronchoscopy, its limitation is a wide delivery system that requires a large caliber deployment conductor.…”

Section: Discussionmentioning

confidence: 99%

Placement of self‐expanding metallic tracheobronchial Y stent with laryngeal mask airway using conscious sedation under fluoroscopic guidance

et al. 2020

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Background Central airway obstruction and fistula are treated with a tracheobronchial Y stent. In the currently used self‐expandable metal Y stents, the delivery system is 8 mm in diameter and requires either a 9 mm tracheal tube or rigid bronchoscope to enable airway control during insertion. In this study we present a novel technique of laryngeal mask airway (LMA) assisted Y stent insertion, enabling airway control during deployment of the Y stent. Methods All procedures using LMA in assisting Y stent insertions between 2014–2020 were reviewed. Data collected included demographics, clinical diagnosis and disease characteristics, indication, procedural success rates, clinical outcome and survival. Results A total of 10 patients with a median age of 61.5 years (range 37–73) underwent LMA assisted Y stent insertion. Indications for stent insertion were malignant disease with central airway obstruction or fistula. In all cases airway patency was achieved leading to improvement of symptoms and performance status. No procedural complications were reported. The median survival was 4.5 weeks (range: 2–26). Conclusions LMA assisted Y stent insertion enables airway control during the procedure. In comparison to silicone Y stent insertion, the procedure is less cumbersome, shorter in duration and does not require the use of general anesthesia or rigid bronchoscopy. Key points Significant findings of the study LMA assisted Y stent insertion enables airway control during the implantation of metallic self‐expanding Y stent. The procedure does not require the use of general anesthesia or rigid bronchoscopy. What this study adds In this study we present the technique and outcomes of LMA assisted Y stent insertion. This method of Y stent insertion provides an additional treatment option for patients with central airway obstruction and fistula.

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“…In the present case series, all of the stents used to treat airway obstructions were of a self-expanding metallic variety, as has been used in treating airway obstruction, airway-alimentary tract fistula, or airway stump fistula. [9–11,14,15] The most used airway stents for airway obstruction are tubular and Y-shaped stents. [9–11] It is also possible to insert self-expanding metallic airway stents with fluoroscopic guidance, offering those positioning the stent a complete panoramic view of the airway in order to optimally position and release the stent at the site of the obstruction.…”

Section: Discussionmentioning

confidence: 99%

Double stent insertion for combined malignant airway and superior vena cava obstruction

Ren

Cao

et al. 2019

Medicine

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The present study sought to assess the feasibility and effectiveness of double stent insertion as a means of managing combined malignant airway and superior vena cava (SVC) obstruction (CMASO). From July 2010 to January 2018, twelve consecutive patients with CMASO were treated by double stent insertion (airway and SVC stents) in our centers. We assessed data pertaining to both technical and clinical success rates, as well as to long-term patient outcomes. The use of double stents (12 airway stents and 19 SVC stents) was technically successful in all study subjects, with a 0 to 92 days period between the 2 stent insertions (mean 27.8 days). Patients did not show evidence of any procedure-related complications. Mean patient Hugh-Jones grades improved from 4.4 ± 0.5 before inserting the airway stent down to 1.2 ± 0.4 following this insertion ( P < .001). Mean SVC pressure was reduced from 17.5 ± 2.8 mm Hg before the stent insertion down to 6.7 ± 1.4 mm Hg following this insertion ( P < .001). Fifty-six days after insertion, a single patient experienced re-obstruction of their SVC stent. All patients died within the follow-up period, with a median survival time of 113 days for these 12 patients. This double stent insertion protocol is both effective and safe as a means of offering palliative care to those with CMASO.

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Application of combined-type Y-shaped covered metallic stents for the treatment of gastrotracheal fistulas and gastrobronchial fistulas

Abstract: Deployment of the combined-type Y-shaped integrated self-expanding covered metallic stent proved to be an effective, safe, and minimally invasive procedure for complex GTFs and GBFs. Our patients tolerated the stents well and had good palliation of their symptoms.

Cited by 23 publications

References 26 publications

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Placement of self‐expanding metallic tracheobronchial Y stent with laryngeal mask airway using conscious sedation under fluoroscopic guidance

Double stent insertion for combined malignant airway and superior vena cava obstruction

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