title: Stent-associated esophagorespiratory fistulas: incidence and risk factors.
abstract: BACKGROUND
  Esophageal self-expandable stents (SESs) effectively treat strictures and leaks but may be complicated by a stent-associated esophagorespiratory fistula (SERF). Little is known about SERFs.
  
  
  OBJECTIVE
  To determine the incidence, morbidity, mortality, and risk factors for SERF.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Single referral center.
  
  
  METHODS
  All adults undergoing esophageal SES placement during a 10-year period.
  
  
  METHODS
  Stent placement.
  
  
  METHODS
  Occurrence of SERF, morbidity, and mortality.
  
  
  RESULTS
  A total of 16 of 397 (4.0%) patients developed SERF at a median of 5 months after stent placement (range 0.4-53 months) including 6 of 94 (6%), 10 of 71 (14%), and 0 of 232 (0%) of those with lesions in the proximal, middle, and distal esophagus, respectively (overall P < .001). SERF occurred in 10% of those with proximal and mid-esophageal lesions, including 14% with benign strictures, 9% with malignant strictures, and none with other indications for SES placement (P = .27). The risk was highest (18%) in patients with benign anastomotic strictures. Risk factors for development of SERF included a higher Charlson comorbidity index score (odds ratio [OR] 1.47 for every 1-point increase; P = .04) and history of radiation therapy (OR 9.41; P = .03). Morbidity associated with SERF included need for lifelong feeding tubes in 11 of 22 (50%) and/or tracheostomy or mechanical ventilation in 5 of 22 (23%). Median survival after diagnosis was 4.5 months (range 0.35-67), and 7 patients survived less than 30 days.
  
  
  CONCLUSIONS
  Retrospective design, limited statistical power.
  
  
  CONCLUSIONS
  SERF is a morbid complication of SES placement for strictures of the proximal and mid-esophagus. The dominant risk factors for development of SERF are prior radiation therapy and comorbidity score.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Bick
authors.forename: Louis M Wong Kee
authors.initials: LM
authors.lastname: Song
authors.forename: Navtej S
authors.initials: NS
authors.lastname: Buttar
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: Fabien
authors.initials: F
authors.lastname: Maldonado
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Enders
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D016022:Case-Control Studies; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D014138:Tracheoesophageal Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome