title: Treatment of esophagopleural fistulas using covered retrievable expandable metallic stents.
abstract: OBJECTIVE
  To evaluate the clinical efficacy of placement of covered retrievable expandable metallic stents for esophagopleural fistulas (EPFs).
  
  
  METHODS
  During the period 1997-2013, nine patients with EPF were treated using covered retrievable expandable metallic stents. The underlying causes of EPF were esophageal carcinoma (n = 6), lung cancer (n = 2), and postoperative empyema for Boerhaave syndrome (n = 1).
  
  
  RESULTS
  Technical success was achieved in eight patients (88.9%). In one patient, incomplete EPF closure was due to incomplete stent expansion. Clinical success, defined as complete EPF closure within 7 days, was achieved in five patients (55.6%). Overall fistula persistence (n = 1) or reopening (n = 4) occurred in five patients (55.6%) 0-15 days after stent placement. The causes of reopening were due to the gap between the stent and the esophagus (n = 3) or stent migration (n = 1). For fistula persistence or reopening, additional interventional management, such as gastrostomy, stent removal, or stent reinsertion, was performed. Stent migration occurred as a complication in one patient with EPF from a benign cause secondary to postoperative empyema. In the eight patients who died during the follow-up period, the mean and median survival times were 78.8 days and 46 days, respectively.
  
  
  CONCLUSIONS
  Placement of a covered expandable metallic esophageal stent for the palliative treatment of EPF is technically feasible, although the rate of clinical success was poor secondary to fistula persistence or reopening. Fistula reopening was caused by the gap between the stent and the esophagus or by stent migration, and additional interventional treatment was useful to ensure enteral nutritional support.
authors: Department of Radiological Science (T.-H.K.), College of Health Science, Kangwon National University, Gangwon Province, South Korea.
authors: Tae-Hyung
authors: TH
authors: Kim
authors: Department of Radiology and Research Institute of Radiology (J.H.S., J.-H.P., J.H.K., H.-Y.S.), University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Electronic address: jhshin@amc.seoul.kr.
authors: Ji Hoon
authors: JH
authors: Shin
authors: Department of Radiology (K.R.K.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Kyung Rae
authors: KR
authors: Kim
authors: Department of Radiology and Research Institute of Radiology (J.H.S., J.-H.P., J.H.K., H.-Y.S.), University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
authors: Jung-Hoon
authors: JH
authors: Park
authors: Department of Radiology and Research Institute of Radiology (J.H.S., J.-H.P., J.H.K., H.-Y.S.), University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
authors: Jin Hyoung
authors: JH
authors: Kim
authors: Department of Radiology and Research Institute of Radiology (J.H.S., J.-H.P., J.H.K., H.-Y.S.), University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
authors: Ho-Young
authors: HY
authors: Song
mesh_terms: D000328:Adult; D000368:Aged; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011474:Prosthesis Design; D012008:Recurrence; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D008670:Metals