Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes

Abstract

This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.

Bronchoscopic advances in the management of aerodigestive fistulas

“…Esophageal stenting using a self-expanding metallic stent (SEMS) has been used since 1980 (7). They are the most frequently used treatment modality (1). They are divided into partially covered stents and fully covered stents ( Figure 1).…”

“…They are divided into partially covered stents and fully covered stents ( Figure 1). While being equally effective at sealing the ADF, the overall clinical success rate at preventing aspiration range from 54-74% (1,17,18). Partially covered stents tend to embed in the esophageal wall making them less prone to migration but have a higher rate of tumor ingrowth.…”

“…Double stenting (or parallel stenting) refer to the placement of an airway as well as an esophageal stent. Multiple studies have reported placement of an esophageal tube (23) or SEMS (1,(20)(21)(22)24). The airway stenting was performed using SEMS (1,(20)(21)(22)24), Silicone stent (1,(22)(23)(24), or dynamic stent (23).…”

“…ADF occurs in 5-15% of patients with esophageal or lung cancer, but may occur after trauma, or as a complication of surgery, stent placement and high endotracheal tube cuff pressure (1).…”

“…In another series of 25 ADF, fistulas were localized to the proximal esophagus in 48%, the mid-esophagus in 20% and the distal esophagus in 24% of patients. In 8% (2/25) multiple fistulas were present (1). Although, most fistulae develop between the central airways and esophagus, some fistulae develop between the esophagus or stomach and the distal bronchi, small airways or lung parenchyma (2,3,10).…”