The management of malignant esophago-respiratory fistulas with a cuffed prosthesis.
Peroral intubation with a standard prosthesis fails to occlude inoperable malignant esophago-respiratory fistulas located above the narrowed segment, or when there is little or no stricture at all. Ten patients with malignant esophago-respiratory fistulas were intubated perorally with a prosthesis surrounded by a foam ruber cuff contained in a silicone sheath, in which a vacuum can be created. The type of fistula was esophago-bronchial in 6 patients, esophago-tracheal in 3 patients, and gastro-tracheal in 1 patient. The fistula was located above the stricture in 8 patients and in a malignancy without a stricture in 2 patients. The diameter of the opening of the fistula ranged between 1 and 3 cm. Complications with the cuffed tube were recurrent leakage after a period of 30 days in situ in 1 patient, and compression of the trachea immediately after intubation in 1 patient. Adequate palliation, that is, no symptoms related to the fistula, good transit of food and discharge from hospital within a few days was achieved in 9 patients for an average period of 37.2 days (10-84 days). The cuffed esophageal prosthesis can improve the quality of life in patients with malignant esophago-respiratory fistulas that do not respond to conventional intubation.
Department of Internal Medicine II, University Hospital Rotterdam Dijkzigt, The Netherlands.
M L
ML
Hordijk
J
J
Dees
M
M
van Blankenstein
D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000628:therapy*; D004937:Esophageal Fistula / Q000628:therapy*; D005260:Female; D005747:Gastric Fistula / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000295:instrumentation; D019736:Prostheses and Implants; D011474:Prosthesis Design; D014133:Tracheal Diseases / Q000628:therapy; D014138:Tracheoesophageal Fistula / Q000628:therapy*