Esophageal fistula sealing: choice of stent, practical management, and cost

Benign Bronchoesophageal Fistula in Adults: Endoscopic Closure as Primary Treatment

“…This has led to the development of endoscopic and even medical treatment methods. 4,[7][8][9][10][11] For example, while covered esophageal-wall-stent placement has been described for malignant fistulas associated with stricture, 16,17 esophageal stent insertion would probably not have been suitable for benign BEFs because the latter have no strictures to hold the stents in place. To date, there have been few reports about the results of primary endoscopic treatment for benign BEFs in adults.…”

Leakage of Jejunal End of Roux Limb after Total Gastrectomy: Management with a Placement of a Covered Metallic Stent: Case Report

“…Surgical palliation is indicated in selected cases with peritonitis and paralytic ileus, but because of the invasiveness of the intervention and the poor general condition of these patients, it is associated with significant complications. Although there was no report for postoperative leakage after gastric surgery, metallic stent placement has shown encouraging results for the palliation of malignant gastrointestinal tract obstruction and fistula (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In this report, we present a case of the postoperative leakage after total gastrectomy which was successfully treated with temporary placement of a covered metallic stent.…”

To stent or not to stent?

“…Several recent reports have also presented limited experience using expandable metal stents to seal benign TE fistulae and spontaneous esophageal rupture (Boerhaave's syndrome) (17)(18)(19)(20). Dumonceau et al reported three patients with benign esophageal fistulae; etiologies included radiation-induced ischemia, erosion of a tracheostomy cannula, and a postoperative fistula after repair of a traumatic bronchial rupture in a child (17).…”

“…Dumonceau et al reported three patients with benign esophageal fistulae; etiologies included radiation-induced ischemia, erosion of a tracheostomy cannula, and a postoperative fistula after repair of a traumatic bronchial rupture in a child (17). All were poor surgical candidates, given the existing comorbidities; therefore, covered stents were placed as a last resort.…”

“…However, given the mixed results and limited experience, "expanding the indications for esophageal stenting to include benign [esophageal disruption] is not justified at this time, due to the lack of long-term data. This would require improvement in materials, such as the development of biodegradable or removable stents" (17).…”