Gastrotracheal and gastrobronchial fistulas: management with covered expandable metallic stents.
OBJECTIVE
The present study evaluated the clinical results of covered tracheobronchial metallic stent placement in the management of gastrotracheal fistulas (GTFs) and gastrobronchial fistulas (GBFs).


METHODS
Sixteen patients with GTFs or GBFs after esophagogastrectomy were treated with one of two types of covered tracheobronchial metallic stents: a hinged stent or a straight stent. These included 12 GTFs and four GBFs. Thirteen hinged stents and three straight stents were placed during the initial procedure. Data regarding the technical success of stent placement, initial clinical success and failure, fistula reopening, and complications were obtained.


RESULTS
Stent placement was technically successful in all patients. The stent completely sealed off the fistula in 12 of 16 patients (75% initial clinical success rate), whereas the remaining four patients (25%) had persistent aspiration symptoms as a result of incomplete GTF or GBF closure (ie, initial clinical failure). During follow-up, the fistula reopened in three of the 12 patients in whom initial clinical success was achieved (25%). Two reopened fistulas were sealed off with stent placement, and one was treated with a nasoenteric feeding tube and a nasogastric decompression tube. All patients died during the 1-year follow-up period; mean survival time was 17 +/- 3.02 weeks (range, 1-42 weeks) after stent placement. Mean survival in patients in whom initial clinical success was achieved was significantly longer than in patients with initial clinical failure (P = .003; log-rank test).


CONCLUSIONS
Use of covered metallic stents appears to be a safe and moderately effective procedure to occlude GTFs and GBFs.
Li
Yong-Dong
YD
Department of Radiology, Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600 Yi Shan Road, Shanghai 200233, ROC. liyongdong2009@tom.com
Li
Ming-Hua
MH
Han
Xin-Wei
XW
Wu
Gang
G
Li
Wen-Bin
WB
D000328:Adult; D000368:Aged; D001982:Bronchial Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D004935:Esophageal Diseases / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016156:Respiratory Tract Fistula / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015607:Stents; D014133:Tracheal Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*