Esophagorespiratory Fistula: Long-term Results of Palliative Treatment with Covered Expandable Metallic Stents in 61 Patients

Abstract

Covered expandable metallic stents were placed in 61 patients with ERFs, but the initial clinical success rate was poor and the rate of reopening was high; however, interventional treatment was effective for sealing off reopened ERFs.

Migration of a self expandable metallic stent in malignant esophageal-pleural fistula - A complication that needs active surveillance

“…Causes of esophageal-pleural fistula include direct tumor incursion and ensuing perforation or consequence of radiation therapy, laser therapy, chemotherapy, or pre-existing stents [2] . To decrease mortality, the diagnosis of esophago-pleural fistulas should be made timely; superlatively before the inception of pneumonia or lung abscesses.…”

“…Esophageal stenting seems to be the most reasonable palliative measure, with 80%-100% effectiveness of covered self expanding metal stents reported in recent studies [6] . In 80% of cases, after placement of the stent there is complete closure of the fistula, nevertheless complications are familiar [2] ; which comprise of unrelenting chest pain, tracheal or esophageal mucosa necrosis due to pressure, development of granulation tissue causing stenosis, dyspnoea due to compression of the trachea, perforation, hemorrhage (which may be apparent as hemoptysis or hematemesis) and stent migration. Incidence of stent migration is 5% to 15% and urgent necessity for stent replacement [3,9,10] ; with these logistics, tumor in-growth through the stent metal in majority of patients with malignant esophageal fistulas covered stents are used as the cover prevent mesh [11] .…”

“…This complication is called a malignant esophageal fistula [1] . The occurrence of such fistulas is 10%-15% and life span is less than 7 weeks in patients who do not undergo treatment [2][3][4] . In patients with esophageal cancer, incidence of malignant esophageal-pleural fistula (EPF) is 5%-15% [5,6] .…”

Surgery for nonsmall cell lung cancer

“…Palliative radiotherapy is often used subsequently [204,205]. Tracheo-oesophageal fistulas are best palliated by insertion of a covered stent in the oesophagus and a stent in the airway to prevent secondary collapse of the airway [206]. Lastly, endovascular stenting provides rapid relief of symptoms in superior vena cava syndrome with minimal morbidity and complications [207].…”

An unusual case of malignant oesophago-pulmonary fistula diagnosed by multidetector computed tomography

“…If left untreated it may lead to multiple pulmonary fistulae and contaminate the respiratory tract, causing pneumonitis and lung abscesses that may eventually lead to sepsis, acute respiratory distress syndrome (ARDS), and death. 3,4 The investigation of these fistulae may require plain radiography, contrast radiography, oesophagoscopy, and bronchoscopy. Computed tomography has significantly improved the investigation of these cases, especially with the advent of MDCT.…”