Current treatment of tracheoesophageal fistula

Abstract

Tracheoesophageal fistulas (TEFs) often occur with esophageal or bronchial carcinoma. Currently, we rely on implantation of delicate devices, such as self-expanding and silicone stents, in the esophagus or trachea to cover the fistula and expand the stenosis in order to relieve patient pain. However, because each case is different, our approach may not be effective for every patient. Consequently, new devices and technology have emerged to address these situations, such as degradable stents, Amplatzer^® devices, endobronchial one-way umbrella-shaped valves, and transplantation of mesenchymal stem cells. Although some studies have shown such alternatives can be reasonable solutions in special cases, further development of other new and effectual techniques is of utmost importance.

Keywords: covered self-expanding stents; silicone stents; tracheoesophageal fistula.

Figure 1.

Eight locations of the central airway: (1) location I, upper third of the trachea; (2) location II, middle third of the trachea; (3) location III, lower third of the trachea; (4) location IV, trachea carina; (5) location V, right main bronchus; (6) location VI, right middle bronchus; (7) location VII, proximal of left main bronchus; (8) location VIII, distal of left main bronchus.

Figure 2.

Picture A shows a right lung carcinoma patient who had been performed a partial lobectomy surgery 2 months ago, and presently suffering a fever and constantly secreting phlegm. Picture B is an esophagus cancer patient, in whom after resection surgery, a right main bronchus-located transesopogeal fistula (TEF) was formed. Picture C shows a patient just resembling patient A, with a different location of Part VII. Picture D shows a patient with tremendous high TEF, a great volume of gastric content draw back to trachea, then flow into the lungs via fistula attributed to the suction pressure of inspiration.

Figure 3.

This picture ABCD shows the counterparts imaging of Figure 2. Picture A shows a lipodolo hysecrosalpingography of counterpart of Figure 2. Picture B shows the coronal view of the counterpart of Figure 2. Picture C and D show the common computerized tompography scan of counterpart of Figure 2.