Treatment of Malignant Esophageal Fistulas: Fluoroscopic Placement of Esophageal SEMS, Endoscopically-assisted through Surgical Gastrostomy. A Case Report

Abstract

Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035” guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible.
 Abbreviations: ERCP: endoscopic retrograde cholangio-pancreatography; GI: gastrointestinal; SEMS: self-expandable metallic stents.

Esophageal pulmonary fistula – a rare complication of radiation therapy: a case report

“…Fistulae may prove life-threatening [ 11 ]. In the absence of appropriate treatment, they can lead to pneumonia, lung abscess, and eventually sepsis or acute respiratory distress syndrome [ 1 ].…”

“…In the absence of appropriate treatment, they can lead to pneumonia, lung abscess, and eventually sepsis or acute respiratory distress syndrome [ 1 ]. Early treatment is mandatory for malignant fistulae and relies on palliative treatment such as stenting, which provides immediate symptom relief [ 1 , 4 , 11 – 13 ]. Fully covered self-expandable metallic stents have recently emerged as a superior treatment in managing fistulae owing to their high efficiency [ 10 , 11 , 13 ].…”

“…Early treatment is mandatory for malignant fistulae and relies on palliative treatment such as stenting, which provides immediate symptom relief [ 1 , 4 , 11 – 13 ]. Fully covered self-expandable metallic stents have recently emerged as a superior treatment in managing fistulae owing to their high efficiency [ 10 , 11 , 13 ]. These devices are recommended by the European Society of Gastrointestinal Endoscopy and are indicated in the event of dysphagia, esophageal compression, or lung cancer infiltrating the esophagus [ 12 , 13 ].…”

“…These devices are recommended by the European Society of Gastrointestinal Endoscopy and are indicated in the event of dysphagia, esophageal compression, or lung cancer infiltrating the esophagus [ 12 , 13 ]. Their success rate varies from 70% to 100%, depending on the report [ 11 , 13 ]. Complications such as stent migration, bleeding, granulation formation, and foreign body sensation are well known [ 10 , 13 , 14 ].…”

Retrograde esophageal stenting for esophageal stenosis following esophageal atresia repair

“…The present case involved a complication after esophageal dilation that may preclude subsequent endoscopic therapy, as the guidewire could not be passed via the oral route. The use of retrograde esophageal stenting as rescue therapy has been described for palliation of malignant obstruction [3] and fistula [4]. To the best of our knowledge, this is the first report to describe this technique to treat anastomosis stenosis in a case of esophageal atresia in an infant.…”