Abstract
Background and Aims
Esophagorespiratory fistulas (ERF) are a devastating complication of benign and malignant etiologies. ERF are associated with high mortality, short survival, and poor quality of life. We performed a multicenter analysis of patients with ERF undergoing endoscopic treatment.
Methods
Multicentre retrospective study.
Results
We analyzed 25 patients undergoing 35 procedures over an 8-year period. Our data showed high technical success rates (97.1% of procedures) and with good, but not ideal, clinical success rates (60% of procedures, 80% of patients), which were defined as fistula closure confirmed by radiographic or repeat endoscopic evaluation and/or a lack of recurrent episodes of clinical aspiration to focus on durable ERF closure as opposed to only initial success. Proximal ERF were the most difficult to manage with the lowest overall clinical success rates, highest rates of recurrent aspiration despite endoscopic therapy, highest adverse events, and shortest survival times. Adverse events occurred in 40.0% of our patients and were all minor. Treatment allowed for diet advancement in 75% of patients.
Conclusion
This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Tomaselli F, Maier A, Sankin O, Woltsche M, Pinter H, Smolle-Jüttner FM. Successful endoscopical sealing of malignant esophageotracheal fistulae by using a covered self-expandable stenting system. Eur J Cardiothorac Surg. 2001;20:734–738.
Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am. 2003;13:271–289.
Balazs A, Galambos Z, Kupcsulik PK. Characteristics of esophagorespiratory fistulas resulting from esophageal cancers: a single-center study on 243 cases in a 20-year period. World J Surg. 2009;33:994–1001.
Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg. 2008;34:1103–1107.
Herth FJ, Peter S, Baty F, Eberhardt R, Leuppi JD, Chhajed PN. Combined airway and oesophageal stenting in malignant airway-oesophageal fistulas: a prospective study. Eur Respir J. 2010;36:1370–1374.
Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, Sung KB. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology. 2004;232:252–259.
Ross WA, Alkassab F, Lynch PM, et al. Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas. Gastrointest Endosc. 2007;65:70–76.
Zori AG, Jantz MA, Forsmark CE, Wagh MS. Simultaneous dual scope endotherapy of esophago-airway fistulas and obstructions. Dis Esophagus. 2014;27:428–434.
Hu Y, Zhao YF, Chen LQ, et al. Comparative study of different treatments for malignant tracheoesophageal/bronchoesophageal fistulae. Dis Esophagus. 2009;22:526–531.
Kim KR, Shin JH, Song HY, et al. Palliative treatment of malignant esophagopulmonary fistulas with covered expandable metallic stents. AJR Am J Roentgenol. 2009;193:W278–W282.
Wang MQ, Sze DY, Wang ZP, Wang ZQ, Gao YA, Dake MD. Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas. J Vasc Interv Radiol. 2001;12:465–474.
Adler DG, Pleskow DK. Closure of a benign tracheoesophageal fistula by using a coated, self-expanding plastic stent in a patient with a history of esophageal atresia. Gastrointest Endosc. 2005;61:765–768.
Shin JH, Kim JH, Song HY. Interventional management of esophagorespiratory fistula. Korean J Radiol. 2010;11:133–140.
Weigert N, Neuhaus H, Rösch T, Hoffmann W, Dittler HJ, Classen M. Treatment of esophagorespiratory fistulas with silicone-coated self-expanding metal stents. Gastrointest Endosc. 1995;41:490–496.
May A, Ell C. Palliative treatment of malignant esophagorespiratory fistulas with Gianturco-Z stents. A prospective clinical trial and review of the literature on covered metal stents. Am J Gastroenterol. 1998;93:532–535.
Kozarek RA, Raltz S, Brugge WR, et al. Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula. Gastrointest Endosc. 1996;44:562–567.
Porumb V, Cozorici A, Andrese E, Makkai-Popa S, Luncă S, Dimofte G. Palliative treatment of malignant esophagopulmonary fistulas with covered self-expandable metallic stents (SEMSS). A single center experience. Rev Med Chir Soc Med Nat Iasi. 2015;119:425–430.
Kvale PA, Simoff M, Prakash UB, American College of Chest Physicians. Lung cancer. Palliative care. Chest. 2003;123:284S–311S.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Adler is a consultant to Merit Medical and Boston Scientific. Ali Siddiqui is a consultant to Boston Scientific. The other authors have no disclosures.
Rights and permissions
About this article
Cite this article
Silon, B., Siddiqui, A.A., Taylor, L.J. et al. Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes. Dig Dis Sci 62, 424–431 (2017). https://doi.org/10.1007/s10620-016-4390-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-016-4390-0