Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses.

Morgan, Robert; Ellul, J. P. M.; Denton, Erika R. E.; Glynos, Michael K.; Mason, Robert C.; Adam, Andy

doi:10.1148/radiology.204.2.9240548

Cited by 151 publications

(81 citation statements)

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“…Stent placement for esophagorespiratory fistulas. Placement of a covered metal stent is the treatment of choice for esophagorespiratory fistulas [21][22][23][24][25]. Complete sealing of a fistula can be established in more than 90% of patients with no clear difference between the presently available covered metal stents.…”

Section: Consmentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

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Section: Consmentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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“…These forms of treatment have low success rates and most patients undergo gradual deterioration as a result of undemutrition and sepsis. Several authors have recently reported high success rates following closure of perforations using covered metallic stents [2][3][4][5]. We recently encountered a patient with a perforation that could not be closed by a standard covered Wallstent endoprosthesis because the upper esophagus was dilated as a result of esophageal obstruction.…”

mentioning

confidence: 99%

Treatment of a malignant esophageal perforation with a prototype conical wallstent

Scott-Mackie

Morgan

Mason

et al. 1998

Cardiovasc Intervent Radiol

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“…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] .…”

Section: Discussionmentioning

confidence: 99%

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

Singla

Gupta

Cruz

et al. 2014

CRIM

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Development of malignant esophago-pleural fistulas is relatively rare but life-threatening complication. We present a 50 year-old female patient with 6 months history of distal esophageal carcinoma. Patient presented with right sided chest pain, dysphagia, dyspnoea, cough and fever. Right side pyopneumothorax was diagnosed and intercostal drainage (ICD) tube was inserted. Presence of food material in the drainage bag led to the diagnosis of oesophageal-pleural fistula. Self expandable stent was placed, however 1 month later stent migration was observed and patient expired due to worsening pyopneumothorax and sepsis.

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Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses.

Cited by 151 publications

References 0 publications

Palliative therapy

Palliative therapy

Treatment of a malignant esophageal perforation with a prototype conical wallstent

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

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