title: Airway complications after covered stent placement for malignant esophageal stricture: special reference to radiation therapy.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the characteristics of airway complications and survival with special reference to radiation therapy in the care of patients undergoing covered stent placement for malignant esophageal strictures.
  
  
  METHODS
  A total of 208 patients who underwent stent placement with or without palliative radiation therapy for inoperable esophageal cancer were included. The endpoints were frequency, type, and management of airway complications; association between occurrence of airway complications and radiation therapy history; and differences in stent-to-complication interval and survival period after esophageal stenting between patients who underwent radiation therapy before and those who underwent radiation therapy after stent placement.
  
  
  RESULTS
  Airway complications occurred in 23 patients (11.1%): 18 (78.3%) had esophagorespiratory fistula, three (13.0%) had airway narrowing, and two (8.7%) had both complications. The frequency of airway complications was significantly greater among patients who underwent RT than those who did not (p = 0.005) but was not significantly different between the radiation before stenting and radiation after stenting groups (p = 0.158). The median stent-to-complication interval and survival period after esophageal stenting were significantly shorter in the radiation before stenting group than in the radiation after stenting group (p = 0.002, p = 0.001).
  
  
  CONCLUSIONS
  Esophagorespiratory fistula is much more common than airway narrowing as an airway complication. The rate of complications increases significantly in association with radiation therapy among patients with malignant esophageal stricture. Clinicians need to be aware of earlier airway complications and poorer prognosis among patients who undergo radiation therapy before placement of an esophageal stent than in patients who undergo radiation after stent placement.
authors.affiliation: Department of Radiology, Kwandong University College of Medicine, Myongji Hospital, Goyang-si, Gyeonggi-do, South Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Park
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Song
authors.forename: Seong Yoon
authors.initials: SY
authors.lastname: Yi
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D004940:Esophageal Stenosis / Q000209:etiology / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome