Oesophagobronchial perforations after placement of an oesophageal self‐expanding metallic stent

Abstract

An oesophageal fully covered self‐expanding metallic stent (SEMS) was placed in a 54‐year‐old Japanese man to relieve dysphagia owing to a stage cT1bN3M1c lung adenocarcinoma. High expression of programmed cell death‐ligand 1 was microscopically confirmed, and pembrolizumab was subsequently administered. Several days later, the patient was hospitalized with septic shock, and severe mediastinitis and pneumonia caused by oesophageal SEMS‐induced oesophageal and bronchial perforations were observed. Thoracoscopic surgery was performed to drain the mediastinal abscess, and an additional oesophageal SEMS was placed to close the oesophageal perforation. The patient gradually recovered from the potentially fatal infection, and the SEMS was retrieved after confirming perforation closure. We re‐initiated pembrolizumab administration, and the patient responded well. The present report reveals the potential risk and effectiveness of SEMS, especially when administered with immune checkpoint inhibitors.

Bronchoesophageal fistula formation after three courses of nivolumab for carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma

“…One report showed that one cycle of pembrolizumab caused tracheoesophageal fistula formation in a patient with squamous cell lung cancer and bronchial stent in the left bronchus [ 8 ]. Another study showed that one cycle of pembrolizumab caused esophagobronchial perforations after the placement of an esophageal self-expanding metallic stent in a patient with stage IV lung adenocarcinoma [ 9 ]. Based on the above considerations, we might be able to explain the process of fistula formation associated with ICIs ( Fig 4 ).…”