Coated expandable esophageal stents in the treatment of digestive-respiratory fistulas.
BACKGROUND
Malignant digestive-respiratory fistula (DRF) is associated with significant morbidity and mortality. In addition to the other recognized advantages of expandable stents, coated expandable stents can seal off DRF.


METHODS
Eight men and five women, mean age 52 yr, with endoscopically and radiographically proven DRF were treated with the coated Wallstent (Schneider). Eleven had dysphagia, 11 postprandial cough, and two required mechanical ventilation. The DRF was proximal in four, mid-esophageal in seven, and distal in two. Two had a normal esophagus and 11 had stricture.


RESULTS
Stent placement and DRF obliteration were successful in all. During a median follow-up of 157 days (range 30-423), no recurrent DRF were noted. The median dysphagia score improved from 3.4 to 1.3. Respiratory symptoms were corrected in all. A gastrostomy tube was required in three. The only complications were transient chest pain and foreign body sensation in three patients and constant sensation of belching in one. There was no procedure-related mortality.


CONCLUSIONS
In this small group of patients, the coated Wallstent demonstrated excellent palliation of DRF with minimal morbidity and no mortality.
Raijman
I
I
Division of Gastroenterology, University of Texas Health Science Center, MD Anderson Cancer Center, Houston, USA.
Lynch
P
P
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002637:Chest Pain / Q000209:etiology; D003371:Cough / Q000628:therapy; D003680:Deglutition Disorders / Q000628:therapy; D004867:Equipment Design; D004884:Eructation / Q000209:etiology; D004937:Esophageal Fistula / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D004940:Esophageal Stenosis / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000503:physiopathology; D005774:Gastrostomy / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011859:Radiography; D012121:Respiration, Artificial; D012677:Sensation / Q000502:physiology; D015607:Stents / Q000009:adverse effects; D013499:Surface Properties; D014138:Tracheoesophageal Fistula / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome