Palliative treatment of malignant esophagopulmonary fistulas with covered expandable metallic stents

Abstract

Objective: The objective of our study was to evaluate the safety and clinical effectiveness of covered expandable metallic stents for palliative treatment of malignant esophagopulmonary fistulas.

Materials and methods: Between November 1990 and January 2008, 14 patients with fistulas between the esophagus and pulmonary parenchyma were treated with covered expandable metallic esophageal stents. The fistulas were caused by esophageal (n = 9) or bronchogenic (n = 5) carcinomas. At the time of stent placement, all patients had aspiration pneumonia and 11 had lung abscesses (79%). Technical and clinical success, fistula reopening, complications, and survival rates were evaluated.

Results: Stent placement was technically successful in all cases, and there were no immediate procedural complications. Complete fistula sealing resulting in resolution of aspiration symptoms (i.e., clinical success) occurred in 12 patients (86%). During follow-up (mean survival, 100.9 +/- 79.9 days; median survival, 65.5 days; range, 16-275 days), the fistula reopened in two of 12 clinical success patients. One patient (7%) experienced complications resulting from dyspnea due to tracheal compression by the esophageal stent. Although 13 patients died of aspiration pneumonia and the remaining patient died of cancer bleeding, none of the mortalities was related to the stent placement procedure.

Conclusion: The use of covered expandable metallic stents appears to be safe and feasible for the palliative treatment of malignant esophagopulmonary fistulas.