Comparison of conventional and wire mesh expandable prostheses and surgical bypass in patients with malignant esophagorespiratory fistulas.
BACKGROUND
Patients who present with malignant esophagorespiratory fistula continue to provide a significant palliative challenge to gastroenterologists and surgeons.


METHODS
This retrospective series reviewed 29 patients treated with conventional prostheses (13 patients), expandable wire mesh-coated prostheses (12 patients), and surgical bypass with esophageal exclusion (4 patients) between 1982 and 1995.


RESULTS
Improvement in dysphagia scores were comparable in all three groups. Fistula occlusion was more successful with expandable prostheses (92%) compared conventional prostheses (77%); however, reinterventions were required more commonly with expandable prostheses, which were also significantly more expensive on a unit cost basis. In selected patients in whom prosthesis placement either was inappropriate or failed, surgical bypass and esophageal exclusion was undertaken. These patients demonstrated good palliation with minimal morbidity and no mortality.


CONCLUSIONS
Both conventional and expandable prostheses are safe and reasonably straightforward treatment modalities for patients with esophagorespiratory fistulas. Because of ease of insertion and large luminal diameter, expandable metal prostheses will see increasing use in treatment of these difficult patients; however, conventional prostheses will remain a good alternative, especially in patients with extrinsic esophageal compression. When stent placement is either unsuccessful or inadvisable, physiologically fit patients can undergo surgical bypass and esophageal exclusion with good palliation and minimal morbidity and mortality.
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Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Kozarek
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D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications; D002637:Chest Pain / Q000209:etiology; D003106:Colon / Q000637:transplantation; D003365:Costs and Cost Analysis; D003680:Deglutition Disorders / Q000601:surgery; D004937:Esophageal Fistula / Q000601:surgery*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011015:Pneumonia, Aspiration / Q000209:etiology; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000191:economics; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000191:economics; D013270:Stomach / Q000601:surgery; D013526:Surgical Mesh / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome