Esophagorespiratory fistula

Esophagorespiratory fistulas and a dilated esophagus above a stricture. 

Most reports of metallic stenting in the airways in patients with esophageal cancer are limited to case reports. The largest series of esophagorespiratory fistulas treated by airway stenting was recently reported by Sabharwal et al. (2000). Six patients... 

The group of Colt et al. (1992) were the first to report double stents for carcinoma of the esophagus invading the tracheobronchial tree. Ten patients with severe dyspnea at rest due to airway obstruction ( =5) or esophagorespiratory fistulas (n=5) had tracheal (n=5) or bronchial (n=5) stents placed additionally to the esophageal stent. The tracheobronchial stents were Dumon silicone stents. The fistulas were sealed in all cases. The mean survival time was 121 days (range, 12-350 days). 

In the initial paper on the self-expanding polyester stent covered with a thin layer of sificone (Polyflex stent), the authors reported treatment of flve esophagorespiratory fistulas with placement of this stent into the trachea (Wassermann et al. 1997). Three patients had a tracheal stent only two patients had additional previously placed esophageal stents. The Polyflex stent sealed the flstula initially in all flve cases, but this success was only transient. Symptoms recurred in four patients after a median of 1 month and required placement of additional tracheal stents. All patients had deceased after a mean survival of 6.6 months (range, 2-11 months). 

Song et al. (1996) treated three patients with esophagorespiratory fistulas with their own covered (potentially retrievable) self-expanding nitinol stent. All three fistulas were successfully sealed off by stent insertion. In one patient the stent was initially malpositioned with coverage of the right main stem bronchus, but this problem was successfully solved with repositioning. Two patients died after 2 and 3 weeks one patient was alive at 24 weeks with good respiratory status. 

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