Massive hemorrhage following definitive esophageal chemoradiation: teaching case of a fatal aortoesophageal fistula and lessons learned

McGinnis, Gwendolyn J.; Holland, John M.; Thomas, Charles R.; Nabavizadeh, Nima

doi:10.1002/ccr3.1239

Cited by 13 publications

(6 citation statements)

References 26 publications

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“…Moreover, the high pressure exerted by the stent on the esophageal wall can impede blood supply, leading to localized ischemia, necrosis, or ulceration. Local inflammation and growth of the tumor beneath the stent are also potential contributing factors [34,35]. Hence, it is both reasonable and crucial to recognize previous stent implantation as a reliable predictor of AEF.…”

Section: Discussionmentioning

confidence: 99%

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Lu,

Niu,

Pai

et al. 2024

Cancers

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Purpose: To develop and internally validate a novel prediction score to predict the occurrence of arterial–esophageal fistula (AEF) in esophageal cancer bleeding. Methods: This retrospective cohort study enrolled patients with esophageal cancer bleeding in the emergency department. The primary outcome was the diagnosis of AEF. The patients were randomly divided into a derivation group and a validation group. In the derivation stage, a predictive model was developed using logistic regression analysis. Subsequently, internal validation of the model was conducted in the validation cohort during the validation stage to assess its discrimination ability. Results: A total of 257 patients were enrolled in this study. All participants were randomized to a derivation cohort (n = 155) and a validation cohort (n = 102). AEF occurred in 22 patients (14.2%) in the derivation group and 14 patients (13.7%) in the validation group. A predictive model (HEARTS-Score) comprising five variables (hematemesis, active bleeding, serum creatinine level >1.2 mg/dL, prothrombin time >13 s, and previous stent implantation) was established. The HEARTS-Score demonstrated a high discriminative ability in both the derivation and validation cohorts, with c-statistics of 0.90 (95% CI 0.82–0.98) and 0.82 (95% CI 0.72–0.92), respectively. Conclusions: By employing this novel prediction score, clinicians can make more objective risk assessments, optimizing diagnostic strategies and tailoring treatment approaches.

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Section: Discussionmentioning

confidence: 99%

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Lu,

Niu,

Pai

et al. 2024

Cancers

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“…Возможными причинами возникновения АЭС после стентирования пищевода могут быть: прямое повреждение стенки пищевода и аорты, избыточное давление стента на стенку пищевода и аорты с развитием ее ишемии и последующего некроза, непосредственная инвазия опухоли в аорту и механическое воздействие стента на стенку в результате дыхательных движений и передаточной пульсации [16].…”

Section: Discussionunclassified

Aortoesophageal fistula after endoscopic stenting of the esophageal tumor

Belinskaia,

Aleshina,

Borodina

et al. 2023

jour

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This article describes 2 clinical cases of aorto-esophageal fistula (AEF) in patients after endoscopic stenting of the esophagus with a self-expanding mesh stent, which we encountered in our institution (City Clinical Oncology Center, St. Petersburg). In addition, a review of the available literature on this issue was carried out with a special focus on the risk factors for the development of AEF.

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“…Endoscopy is the first choice for investigating upper gastrointestinal bleeding, but UGB caused by AEF with esophageal cancer cannot always be diagnosed in a timely manner. There is also a risk of dislodging clots and causing fatal bleeding with endoscopy[ 13 ]. Previous studies have shown that most patients with stable circulation and an aortic gastrointestinal fistula had undergone gastroscopy, but only approximately 25% were diagnosed with an aortic gastrointestinal fistula in time[ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

Zhong¹,

Li²

2022

WJCC

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BACKGROUND Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature. CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression. CONCLUSION Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.

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Massive hemorrhage following definitive esophageal chemoradiation: teaching case of a fatal aortoesophageal fistula and lessons learned

Cited by 13 publications

References 26 publications

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Aortoesophageal fistula after endoscopic stenting of the esophageal tumor

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

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