Nonexpandable silicone esophageal stents for treatment of malignant tracheoesophageal fistulas: complications and radiographic appearances

Stemerman, David H.; Caroline, Dina F.; Dabezies, Marta A.; Mercader, Virginia P.; Krevsky, Benjamin; Gatenby, Robert A.

doi:10.1007/s002619900131

Cited by 13 publications

(9 citation statements)

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“…Potential complications of stent placement in the oesophagus include perforation when placed in the cervical regions of the oesophagus, respiratory compromise due to compression of major airways and stent migration. Covered SEMS have, nevertheless, an advantage over plastic or silicon stents not only in covering large defects, but also in having lower rates of migration along with adequate maintenance of patency of the passages [3,19,20]. We observed a primary success of fistula closure in all patients who underwent stenting either in the airway, oesophagus or both systems.…”

Section: Discussionmentioning

confidence: 56%

“…Direct surgical fistula closure, bypass or fistula resection do not yield good results, and endoscopic stenting or endoprosthesis are palliative options in this situation [1]. Stents can be placed bronchoscopically in the airways, via EGD in the oesophagus or both in the airways and oesophagus to seal the defect and restore the patency of the passages with resumption of oral feeds [2][3][4][5].…”

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confidence: 99%

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Combined airway and oesophageal stenting in malignant airway–oesophageal fistulas: a prospective study

Herth

Peter²,

Baty³

et al. 2010

Eur Respir J

103

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Malignant airway-oesophageal fistulas (AEF) are a serious complication of advance oesophageal or lung cancer.The aim of this study was to assess the quality of life before and after stent insertion, and to examine the role of treatment and location of AEF as factors influencing survival in AEF patients managed with airway and/or oesophageal stent insertion.112 patients with AEF were included prospectively. 83 (74%) patients had advanced lung cancer and 29 (26%) patients had oesophageal cancers.Airway stents were inserted in 65 (58%) patients, oesophageal stents in 37 (33%) patients, and both airway and oesophageal stents in 10 (9%) patients. Seven (6%) patients developed respiratory failure and required transient ventilator support in the intensive care unit (four patients with airway stenting, two patients with double stents and one patient in the oesophageal stenting group). None of the patients developed stent migration or needed stent repositioning. Overall, mean survival was 236.6 days (airway stent 219.1 days, oesophageal stent 262.8 days and combined airway-oesophageal stent 252.9 days). Backward, stepwise regression revealed the site of stent placement (airway and/or oesophagus; p,0.028), exact location of the fistula in airway (p50.011) and additional treatment with chemotherapy and/or radiation (p,0.001) as independent risk factors predicting increased survival. The mean quality of life score (QoL) was 81 prior to stent insertion and 72 post-stent insertion (p,0.001).Airway and/or oesophageal stent insertion provides an effective approach to improve the QoL in patients with malignant AEF.

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Section: Discussionmentioning

confidence: 56%

mentioning

confidence: 99%

Combined airway and oesophageal stenting in malignant airway–oesophageal fistulas: a prospective study

Herth

Peter²,

Baty³

et al. 2010

Eur Respir J

103

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“…10) (8,14). Esophageal endoprosthesis in the case of eso-tracheal fistula is extremely difficult (15)(16)(17).…”

Section: Descriptionmentioning

confidence: 99%

Laparogastroscopy and Esophageal Stenosis

A¹,

Hassan²,

Smarandache³

et al. 2018

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Chirurgia, 113 (1), 2018 www.revistachirurgia.ro 137 RezumatScop: Tehnică originală ce utilizează instrumentar laparoscopic într-o cameră de lucru endocavitară gastrică cu potenţial de abord al stomacului, esofagului şi D1. Principalul scop al laparogastroscopiei este îmbunătăţirea calităţii vieţii pacientului dezabilitat de tumora esofagiană. Această metodă prezintă multiple avantaje: asigurarea alimentării fiziologice, recoltarea materialelor pentru examenul histopatologic, rezolvarea fistulelor eso-traheale concomitent cu operaţia propusă, rol hemostatic prin compresiune, consum energetic şi plastic redus, reintegrare socio-economică rapidă, menajarea psihică a pacientului. Această metodă creşte durata de supravieţuiere printr-un regim relativ normal. Material şi metodă: Lucrarea vizează 162 de cazuri cu localizări diferite ale tumorii esofagiene, pacienţi cu diferite grade ale stenozei esofagiene, stadii diferite ale neoplasmului esofagian. Au fost incluşi atât pacienţii cu fistule eso-traheale cât şi cei care s-au prezentat cu gastro-sau jejunostomă de alimentaţie. Rezultate: Din 162 de cazuri, 33 de cazuri (20%) cu neoplasm esofagian cervical, 66 (41%) de cazuri cu neoplasm esofagian toracic şi 63 (39%) de cazuri cu neoplasm esofagian abdominal. Tipul histopatologic este reprezentat de 37% adenocarcinoame şi 63% carcinoame scuamoase. Din numărul total de cazuri, 87 (54%) nu au prezentat metastaze, iar 75 (46%) au avut determinări secundare. Cea mai frecevntă localizare a metastazelor este a fost la nivel pulmonar, urmată de hepatic (Fig. 1) şi osos. Analiza acestei intervenţii a demonstrat că s-au înregistrat complicaţii mult mai reduse atât din punctul de vedere numeric cât şi al gravităţii lor, se asigură o durată mai lungă de supravieţuire cu un indice de satisfacţie mult mai mare.

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“…The procedure is usually well tolerated by debilitated patients, it avoids more aggressive procedures, and it generally results in appropriate closure of the fistula and improvement of dyspnea, dysphagia, cough, and episodes of aspiration pneumonia. [2][3][4][5][6][7][8][9] Results, however, are temporary and complications such as wall erosion, bleeding, perforation, mediastinitis, pneumothorax, and vascular fistulas may develop. [2][3][4][6][7][8][9] We have designed a new cufflink-shaped soft silicon prosthesis directed to occlude the aerodigestive connection ( Fig.…”

mentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Results, however, are temporary and complications such as wall erosion, bleeding, perforation, mediastinitis, pneumothorax, and vascular fistulas may develop. [2][3][4][6][7][8][9] We have designed a new cufflink-shaped soft silicon prosthesis directed to occlude the aerodigestive connection ( Fig. 1).…”

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confidence: 99%

New Cufflink-Shaped Silicon Prosthesis for the Palliation of Malignant Tracheobronchial-Esophageal Fistula

Díaz-Jiménez

2005

Journal of Bronchology

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Malignant tracheoesophageal fistula (MTEF) account for more than 50% of all acquired aerodigestive fistulae. It mainly arises from esophageal and lung cancers, and always represent a therapeutic dilemma. The main objective of therapy is minimization of tracheobronchial contamination maintaining appropriate nutrition. To achieve these goals, many palliative measures are available. We present a case of a patient with a MTEF who was successfully treated with a cufflink-shaped silicon prosthesis designed to occlude both orifices of the MTEF. We believe that this prosthesis offers a new treatment option and has potential in the management of MTEF.Key Words: tracheoesophageal fistula, palliative treatment, cufflinkshaped silicon prosthesis (J Bronchol 2005;12:207-209) M alignant tracheoesophageal fistula (MTEF) is a serious complication of cancer arising in the esophagus, lung, or tracheobronchial tree. Approximately 77% of MTEF are related to esophageal cancer, whereas approximately 16% are originated from a primary lung neoplasm. Other tumors represent only a small percentage of this problem: malignant mediastinal node disease, thyroid and laryngeal carcinoma.Poor nutrition, repeated aspiration to the airway, and episodes of pneumonia lead to rapid deterioration and death if this condition is left untreated.Treatment is usually palliative and involves restoration of the swallowing mechanism and prevention of aspiration. In most cases, treatment is individualized and includes esophageal stenting, tracheobronchial stenting, simultaneous stenting of both the trachea and esophagus, esophageal exclusion, esophageal bypass, fistula resection and repair, and radiation therapy. 1,2 Prosthesis placement is considered to be appropriate for most patients with MTEF. A variety of stents have been used for this purpose; silicon and both covered and uncovered selfexpandable metallic prosthesis are commonly indicated. Because insertion of a single device may be insufficient for palliation, parallel stenting of the airway and esophagus is the preferred treatment by many physicians. The procedure is usually well tolerated by debilitated patients, it avoids more aggressive procedures, and it generally results in appropriate closure of the fistula and improvement of dyspnea, dysphagia, cough, and episodes of aspiration pneumonia. [2][3][4][5][6][7][8][9] Results, however, are temporary and complications such as wall erosion, bleeding, perforation, mediastinitis, pneumothorax, and vascular fistulas may develop. 2-4,6-9 We have designed a new cufflink-shaped soft silicon prosthesis directed to occlude the aerodigestive connection (Fig. 1). The prosthesis (DJ silicon prosthesis, Barcelona, Spain); can be safely placed under direct vision using a rigid bronchoscope and an alligator forceps.The DJ prosthesis is made of soft silicone in the shape of a cufflink. It comes in different sizes: 2, 3, 4, and 5-mm diameter for the central axis, whose length is also variable (3, 4, and 5-mm long). The lateral wings are 2 or 3 cm in diameter. The s...

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Nonexpandable silicone esophageal stents for treatment of malignant tracheoesophageal fistulas: complications and radiographic appearances

Abstract: Silicone esophageal stents provide successful short-term palliation for most patients with malignant TEF but are not without associated complications. These complications, however, can usually be detected early using radiographic imaging, permitting remediation.

Cited by 13 publications

References 0 publications

Combined airway and oesophageal stenting in malignant airway–oesophageal fistulas: a prospective study

Combined airway and oesophageal stenting in malignant airway–oesophageal fistulas: a prospective study

Laparogastroscopy and Esophageal Stenosis

New Cufflink-Shaped Silicon Prosthesis for the Palliation of Malignant Tracheobronchial-Esophageal Fistula

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