Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients.
OBJECTIVE
To evaluate long-term clinical results of palliative treatment of esophagorespiratory fistulas (ERFs) with covered expandable metallic stents.


METHODS
Sixty patients with ERFs due to esophageal or bronchogenic carcinoma and one patient with ERF due to pressure necrosis caused by initial esophageal stent placement for esophageal carcinoma were treated with covered expandable esophageal or tracheobronchial metallic stents. Information about technical success of stent placement, initial clinical success and failure, fistula reopening, and complications was obtained. Survival curves for both patient groups with initial clinical success and failure were obtained and compared with Kaplan-Meier methods and log-rank test.


RESULTS
Stent placement was technically successful in all patients, with no immediate procedural complications. The stent completely sealed off the fistula in 49 (80%) of 61 patients so that they had no further aspiration symptoms (initial clinical success). Twelve (20%) of 61 patients had persistent aspiration symptoms due to incomplete ERF closure (initial clinical failure). During follow-up, the fistula reopened in 17 (35%) of 49 patients with initial clinical success: In eight patients, the reopened ERF was sealed off successfully with stent placement or balloon dilation. In two patients with reopened ERF caused by food impaction, the reopened fistula resolved spontaneously. Seven patients did not undergo further treatment. All patients died during follow-up, and mean survival was 13.4 weeks (range, 1-56 weeks) after stent placement. Mean survival in patients with initial clinical success was significantly longer than that in patients with initial clinical failure (15.1 vs 6.2 weeks, P <.05).


CONCLUSIONS
Covered expandable metallic stents were placed in 61 patients with ERFs, but the initial clinical success rate was poor and the rate of reopening was high; however, interventional treatment was effective for sealing off reopened ERFs.
Shin
Ji Hoon
JH
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, Korea.
Song
Ho-Young
HY
Ko
Gi-Young
GY
Lim
Jin-Oh
JO
Yoon
Hyun-Ki
HK
Sung
Kyu-Bo
KB
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001999:Bronchoscopy; D002283:Carcinoma, Bronchogenic / Q000150:complications; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015641:Radiography, Interventional; D012008:Recurrence; D016156:Respiratory Tract Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015607:Stents / Q000009:adverse effects; D014138:Tracheoesophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy