Chinese expert consensus on diagnosis and management of acquired respiratory‐digestive tract fistulas

Abstract

Acquired respiratory‐digestive tract fistulas occur with abnormal communication between the airways and digestive tract, causing the interflow of gas and liquid. Despite advances in surgical methods and the development of multimodal therapy in recent years, patients with acquired respiratory‐digestive tract fistulas continue to exhibit unfavorable clinical outcomes. Therefore, in order to guide clinical practice in China, the Respiratory and Cancer Intervention Alliance of the Beijing Health Promotion Association organized a group of experienced experts in the field to develop this consensus document. Based on a study of clinical application and expert experience in the diagnosis and management of acquired respiratory‐digestive tract fistulas at home and abroad, an Expert Consensus was developed. The panelists recruited comprised experts in pulmonology, oncology, thoracic surgery, interventional radiology, and gastroenterology. PubMed, Chinese Biology Abstract, Chinese Academic Journal, and Wanfang databases were used to identify relevant articles. The guidelines address etiology, classification, pathogenesis, diagnosis and management of acquired respiratory‐digestive tract fistulas. The statements on treatment focus on the indications for different procedures, technical aspects, and preprocedural, post‐procedural and complication management. The proposed guidelines for the diagnosis and management of acquired respiratory‐digestive tract fistulas are the first to be published by Chinese experts. These guidelines provide an in‐depth review of the current evidence and standard of diagnosis and management.

Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing

“…Sealing the TGAF can effectively reduce the risk of aspiration pneumonia, relieve coughing, and restore oral feeding. 1,12 Covered metallic stents and silicon stents are most commonly used to treat airway fistula. 1,12,21,22 Metallic stents can adapt well to tortuous airways because of their self‑expandable properties; however, they also hold potential disadvantages, such as metal fatigue and membrane damage.…”

“…Total energy intake was ensured no less than 35 kcal/(kg day). 12 Pulmonary infection was treated with antibiotics. Karnofsky Performance Score (KPS) was applied to estimate the quality of life of TGAF patients.…”

Regenerative medicine approaches for the management of respiratory tract fistulas

“…According to the Medical Subject Headings (MeSH) definition, a respiratory tract fistula is "an abnormal passage communicating between any component of the respiratory tract or between any part of the respiratory system and surrounding organs". If left untreated, respiratory tract fistulas are associated with high mortality rates [44][45][46]. The most common interventional therapy relies on stent placement.…”

Utilizing Adipose Tissue-Derived Stem Cell Strategies for Obtaining Regeneration of Respiratory Tract Fistulas-A Systematic Review

“…A respiratory tract fistulas is defined as the aberrant passage that communicates among any portion of the respiratory tract or with any part of the respiratory tract or surrounding organs. On leaving untreated, respiratory tract fistulas get correlated with a high chance of mortality [32,33]. The commonest therapy is stent based.…”

“…Hence, immediate therapy is required for prevention of contamination, of the airway as well as aiding in normal feeding. Various strategies have been formed to take care of both acquired non-malignant as well as malignant TEF [32,33,47,49] contamination of the respiratory tract. Furthermore, the utilization of autologous tissue-aided regenerative method may be a useful therapeutic method.…”