Treatment of Malignant Esophageal Fistulas: Fluoroscopic Placement of Esophageal SEMS, Endoscopically-assisted through Surgical Gastrostomy. A Case Report.
Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035" guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible.
Gastroenterology Department, Clinical Emergency Hospital Bucharest, Romania.
Gabriel
G
Constantinescu
Gastroenterology Department, Clinical Emergency Hospital Bucharest, Romania.
Vasile
V
Sandru
Gastroenterology Department, Clinical Emergency Hospital Bucharest, Romania.
Madalina
M
Ilie
Gastroenterology Department, Clinical Emergency Hospital Bucharest, Romania.
Cristian
C
Nedelcu
Intensive Care Unit, Clinical Emergency Hospital Bucharest, Romania.
Radu
R
Tincu
Radiology Department, Clinical Emergency Hospital Bucharest, Romania.
Bogdan
B
Popa
D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000473:pathology; D020701:Esophagoscopes; D004946:Esophagostomy / Q000295:instrumentation*; D005471:Fluoroscopy; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
D008670:Metals