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Edme J, Fournier C, Lepage B, Zea Obando Ep Chateau C, Cellerin L, Wallyn F, Plat G, Héluain V, Lachkar S, Egenod T, Gut Gobert C, Perrot L, Lorut C, Lefebvre A, Vergnon JM, Bourinet V, Roy P, Legodec J, Dutau H, Guibert N. Prognostic factors after therapeutic bronchoscopy for tracheo- or broncho-oesophageal fistulas: results from the EpiGETIF registry. ERJ Open Res 2025; 11:00435-2024. [PMID: 40196712 PMCID: PMC11973716 DOI: 10.1183/23120541.00435-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 10/02/2024] [Indexed: 04/09/2025] Open
Abstract
Introduction Treatment of malignant tracheo- or broncho-oesophageal fistulas (TOF) using therapeutic bronchoscopy (TB) is not standardised and its outcomes are poorly described. This study aimed to analyse the characteristics of patients treated with TB for a TOF and to identify prognostic factors. Methods We analysed data from 96 patients undergoing TB for TOF entered in the EpiGETIF registry between January 2019 and December 2022. Results The mean age was 61.4 years. Median survival after TB was 2.40 months (95% CI 1.81-3.32). Histology was mainly represented by oesophageal (72%) and lung (23%) cancers and did not influence prognosis (p=0.15), whereas smoking did (2.17 versus 3.32 months for nonsmokers, p=0.04). Patients with poor performance status (Eastern Cooperative Oncology Group >2) had shorter survival (1.99 versus 3.02 months, p=0.04). 69% of patients had already received oncologic treatment, with no difference in survival (3.02 versus 2.21 months for treatment-naive patients, p=0.14). Neither the localisation (trachea 61.5%, left main bronchus 34.4%, other 4.1%) nor the size of the fistulas (23% <5 mm, 20% 5-10 mm, 54% >10 mm) impacted survival (p=0.91 and p=0.83, respectively). An airway stent (AS) was placed in 92.7% of patients, mainly self-expanding metallic stents (45%). Patients treated with both an oesophageal stent and AS had a better prognosis than patients treated with an AS alone (2.88 versus 1.77 months, respectively, p=0.02). Conclusion Survival of patients treated with TB for a TOF is very poor, and is impacted by smoking, performance status and the presence of an oesophageal stent.
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Affiliation(s)
- Juliette Edme
- Pulmonology Department, Toulouse University Hospital, Toulouse, France
| | - Clément Fournier
- Interventional Pulmonology Department, Heart and Lung Institute, CHU Lille, Lille, France
| | - Benoit Lepage
- Paul Sabatier III Toulouse University, Toulouse, France
| | | | - Laurent Cellerin
- Pulmonology Department, Nantes University Hospital, Nantes, France
| | - Frederic Wallyn
- Interventional Pulmonology Department, Heart and Lung Institute, CHU Lille, Lille, France
| | - Gavin Plat
- Pulmonology Department, Toulouse University Hospital, Toulouse, France
| | - Valentin Héluain
- Pulmonology Department, Toulouse University Hospital, Toulouse, France
| | - Samy Lachkar
- Pulmonology Department, Rouen University Hospital, Rouen, France
| | - Thomas Egenod
- Pulmonology Department, Limoges University Hospital, Limoges, France
| | | | - Loic Perrot
- Pulmonology Department, Institut Mutualiste Montsouris, Paris, France
| | - Christine Lorut
- Pulmonology Department, Cochin University Hospital, Paris, France
| | - Aurélie Lefebvre
- Pulmonology Department, Cochin University Hospital, Paris, France
| | - Jean Michel Vergnon
- Pulmonology Department, Saint Etienne University Hospital, Saint Etienne, France
| | - Valerian Bourinet
- Pulmonology Department, Saint Pierre University Hospital, La Réunion, France
| | - Pascalin Roy
- Pulmonology Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Julien Legodec
- Pulmonology Department, Saint Joseph Hospital, Marseille, France
| | - Hervé Dutau
- Pulmonology Department, Marseille Nord University Hospital, Marseille, France
| | - Nicolas Guibert
- Pulmonology Department, Toulouse University Hospital, Toulouse, France
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Goh KJ, Lee P, Foo AZX, Tan EH, Ong HS, Hsu AAL. Characteristics and Outcomes of Airway Involvement in Esophageal Cancer. Ann Thorac Surg 2020; 112:912-920. [PMID: 33161017 DOI: 10.1016/j.athoracsur.2020.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/17/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Airway involvement, such as airway invasion, compression, and tracheobronchoesophageal fistula (TEF), in esophageal cancer is associated with significant morbidity. However, the risk factors and outcomes of airway complications remain unclear, with limited evidence to guide management. METHODS This retrospective analysis included 804 patients with a diagnosis of esophageal cancer from 1998 to 2018 at a tertiary care medical center (Singapore General Hospital, Singapore). Patients' demographics, treatment details, and airway involvement, as determined by bronchoscopic evaluation or computed tomographic imaging, were recorded and analyzed to determine risk factors and outcomes of airway involvement. RESULTS The incidence of airway involvement and TEF was 36.6% and 13.1%, respectively. Airway involvement was associated with reduced survival from the time of diagnosis (hazard ratio, 1.52; 95% confidence interval [CI], 1.30 to 1.79) and increased hospitalizations per year (4.53 ± 4.80 vs 2.75 ± 3.68; P < .001). On multivariate analysis, midesophageal tumors (odds ratio [OR], 11.0; 95% CI, 6.3 to 19.0) and upper esophageal tumors (OR, 8.5; 95% CI, 4.7 to 15.6), previous treatment with esophageal stenting (OR, 17.8; 95% CI, 4.1 to 77.6), and chemotherapy or radiotherapy were associated with development of airway involvement. In patients with TEF, treatment with chemotherapy (OR, 0.34; 95% CI, 0.20 to 0.60) and combined airway and esophageal stenting (OR, 0.48; 95% CI, 0.25 to 0.91) were independently associated with improved survival. CONCLUSIONS Airway involvement and TEF are common and are associated with increased morbidity and poorer survival. Clinicians should remain vigilant for airway complications after treatment with esophageal stenting, chemotherapy, or radiotherapy, especially in patients with midesophageal and upper esophageal cancers. In patients with TEFs, survival is improved when they are treated with airway stenting, esophageal stenting, or chemotherapy.
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Affiliation(s)
- Ken Junyang Goh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
| | - Pyng Lee
- Department of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Andrea Zhi Xin Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eng Huat Tan
- Department of Upper Gastrointestinal and Bariatic Surgery, Singapore General Hospital, Singapore
| | - Hock Soo Ong
- Division of Surgery, Singapore General Hospital, Singapore
| | - Anne Ann Ling Hsu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Wang Y, Xu J, Wu Q, Zhou Y, An Z, Lv W, Hu J. Clinical Comparison of Airway Stent Placement in Intervention Room and Operating Room. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:451-459. [PMID: 32517449 PMCID: PMC7309539 DOI: 10.3779/j.issn.1009-3419.2020.104.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Airway stent placement is the effective regimen for central airway obstruction (CAO), while its application scenarios varied. This study aimed to make clinical comparison of airway stent placement in the intervention room and operating room. METHODS Patients underwent airway stent placement between 2014 and 2018 were included in this retrospective case-control study. Clinical performance of airway stent placement in intervention room and operating room were compared. RESULTS 82 patients were included in this study, including 39 in the intervention room and 43 in the operating room. Patients treated in the intervention room had lower Charlson comorbidity index (CCI) (P=0.018) and received less Y-shaped stents (P<0.001). Better clinical response (P=0.026), more stents placed (P<0.001) and longer length of stent (P<0.001) were observed in operating room, while there was no significantly statistical difference of stent-related complications and post-stent survival rate between the two groups. Extracorporeal membrane oxygenation (ECMO) supported airway stent placement procedures were performed in the operating room, which provided definitive safety support for high-risk intervention. CONCLUSIONS Patients with CAO could benefit from the operating room scenario, and airway stent placement in the operating room is more suitable for patients with higher CCI scores and receiving more complicated procedures.
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Affiliation(s)
- Ying Wang
- Operating Room, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qi Wu
- Operating Room, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yuqiong Zhou
- Operating Room, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhou An
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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EndoClot ®SIS Polysaccharide Injection as a Submucosal Fluid Cushion for Endoscopic Mucosal Therapies: Results of Ex Vivo and In Vivo Studies. Dig Dis Sci 2019; 64:2955-2964. [PMID: 31165380 DOI: 10.1007/s10620-019-05686-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 05/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are many studies on submucosal injection materials, but their clinical use is restricted for various reasons. The objective of this study was to compare the feasibility and safety of injected EndoClot®SIS polysaccharide as a submucosal injection material (SFC) in ESD in the pig stomach to that of injected sigMAVisc™ or Eleview™. METHODS Four pig stomachs were used for the ex vivo study. Eighteen pigs were used for the in vivo study. In the ex vivo study, four injections were made in the gastric submucosa to induce submucosal uplift and extend its duration. Tissue change was observed. The in vivo study was performed in 2 steps. First, 3 injections were made in the esophageal mucosa to induce submucosal uplift and extend its duration. Histological change was observed. Second, ESD was performed in the stomach by injecting EndoClot®SIS polysaccharide, sigMAVisc™, or Eleview™ (each, n = 6) as an SFC. The effects of these agents on wound healing were examined. We evaluated the efficacy and safety of endoscopic surgery after EndoClot®SIS polysaccharide injection. RESULTS EndoClot®SIS polysaccharide produced a longer-lasting elevation with clearer margins than was achieved by sigMAVisc™, Eleview™, or 0.9% NaCl and thereby enabled precise ESD without complications, such as bleeding and perforation. No obvious histopathological damage was observed at the injection site on endoscopy and histology. CONCLUSION Submucosally injected EndoClot®SIS polysaccharide increased the effective separation of the mucosa and submucosa and reduced surgical complications. Hence, EndoClot®SIS polysaccharide injection is a safe and effective submucosal injection material.
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Larson B, Adler DG. Endoscopic management of esophagorespiratory fistulas. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bi Y, Ren J, Chen H, Bai L, Han X, Wu G. Combined airway and esophageal stents implantation for malignant tracheobronchial and esophageal disease: A STROBE-compliant article. Medicine (Baltimore) 2019; 98:e14169. [PMID: 30653162 PMCID: PMC6370007 DOI: 10.1097/md.0000000000014169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/12/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
We aimed to evaluate the safety and efficacy of combined airway and esophageal stents under fluoroscopy guidance and local anesthesia for patients with malignant tracheobronchial and esophageal disease. This retrospective analysis included 35 consecutive patients underwent combined stenting from March 2012 to August 2016. All patients underwent chest computed tomography scans before stenting and during follow-up. Thirty-nine airway stents and 43 esophageal covered stents were implanted. The indication of stenting, technical success and postinterventional complications were collected and analyzed. Thirty-nine airway stents and 43 esophageal covered stents were implanted. Stenting failed in 1 airway stent, and 2 esophageal stents, with technology success rates of 97.4% and 95.3%, respectively. No procedure-related death occurred, only 1 patient died from failure of respiration due to esophagotracheal fistula. The median interval between 2 stenting was 13.0 days. Both dyspnea and dysphasia were significantly relieved after stenting. Restenosis after stenting (7.7%) was the most common complication for airway stenting, all these cases required second stenting. Stent migration (7.0%) was the most common complication after esophageal stenting, 1 case had to receive airway stenting and 1 case received replacement of esophageal stent. During follow up, 23 patients were clinically cured, 2 patients were improved in symptoms, and 1 was invalid. Eight deaths were found in total. The 1-year, 3-year, and 5-year survival rates were 82.4%, 78.8%, and 78.8%, respectively. In conclusion, combined airway and esophageal stents implantation under fluoroscopy guidance and local anesthesia are safe and effective for malignant tracheobronchial and esophageal disease.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Hongmei Chen
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Liangliang Bai
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
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Qureshi YA, Muntzer Mughal M, Markar SR, Mohammadi B, George J, Hayward M, Lawrence D. The surgical management of non-malignant aerodigestive fistula. J Cardiothorac Surg 2018; 13:113. [PMID: 30442164 PMCID: PMC6238307 DOI: 10.1186/s13019-018-0799-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/05/2018] [Indexed: 01/07/2023] Open
Abstract
Background Acquired aerodigestive fistula (ADF) are rare, but associated with significant morbidity. Surgery affords the best prospect of cure. We present our experience of the surgical management of ADFs at a specialist unit, highlighting operative techniques, challenges and assess clinical outcomes following intervention. We also illustrate findings of a Hospital Episodes Statistics search for ADFs. Methods A prospectively-maintained database was searched to identify all patients diagnosed with an ADF who were managed at our institution. Of 48 patients with an ADF, eight underwent surgical intervention. Results Four patients underwent an exploration of the ADF with primary repair of the defect. Two of these patients had proximal ADFs, amenable to repair through a neck incision, and two required a thoracotomy. Two patients suffered fistulae secondary to endoscopic therapy and underwent oesophageal exclusion surgery, with subsequent staged reconstruction. Two patients with previous Tuberculosis had a lung segmentectomy and lobectomy respectively, and a further patient in remission after treatment for lymphoma underwent oesophageal resection with synchronous reconstruction. Three patients suffered a complication, with one post-operative mortality. The remaining seven patients all achieved normal oral alimentation, with no evidence of ADF recurrence at a median follow-up of 32 months. Conclusions Surgery to manage ADFs is effective in restoring normal alimentation and alleviates soiling of the airway, with a very low risk of recurrence. Several operative techniques can be utilised dependent on the features of the ADF. Early referral to specialist units is advocated, where the expertise to facilitate the complete management of patients is present, within a multi-disciplinary setting.
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Affiliation(s)
- Yassar A Qureshi
- Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU, UK.
| | - M Muntzer Mughal
- Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Borzoueh Mohammadi
- Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU, UK
| | - Jeremy George
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospital, London, UK
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospital, London, UK
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Qureshi YA, Muntzer Mughal M, Fragkos KC, Lawrence D, George J, Mohammadi B, Dawas K, Booth H. Acquired Adult Aerodigestive Fistula: Classification and Management. J Gastrointest Surg 2018; 22:1785-1794. [PMID: 29943138 PMCID: PMC6153685 DOI: 10.1007/s11605-018-3811-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/07/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acquired aerodigestive fistulae (ADF) are rare, but associated with a high mortality rate. We present our experience of the diagnosis, management and outcomes of patients with ADFs treated at a tertiary centre. Utilising our findings, we propose an anatomical classification system, demonstrating how specific features of an ADF may determine management. METHODS A clinical database was searched and 48 patients with an ADF were identified. A classification system was developed based on anatomical location of the ADF and differences in clinico-pathological features based on this categorisation were performed, with the chi-squared test used for inferential analyses and Kaplan-Meier curves with log-rank test to assess survival. RESULTS Twenty (41.6%) patients developed an ADF secondary to malignancy, with previous radiotherapy (18.7%), post-operative anastomotic dehiscence and endotherapy (14.6% each) representing other causes. Thirty-one patients were managed with tracheal and/or oesophageal stents and eight underwent surgical repair. The classification system demonstrated benign causes of ADF were either proximally or distally sited, whilst a malignant cause resulted in mid-tracheal fistulae (p = 0.001), with the latter associated with poorer survival. ADFs over 20 mm in size were associated with poor survival (p = 0.011), as was the use of previous radiotherapy. Proximal and distal ADFs were associated with improved survival (p = 0.006), as were those patients managed surgically (p = 0.001). CONCLUSION By classifying ADFs, we have demonstrated that anatomical location correlates with the size, history of malignancy, previous radiotherapy and aetiology of ADF, which can affect management. The proposed classification system will aid in formulating multi-modality individualised treatment plans.
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Affiliation(s)
- Yassar A. Qureshi
- 0000 0004 0612 2754grid.439749.4Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU UK
| | - M. Muntzer Mughal
- 0000 0004 0612 2754grid.439749.4Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU UK
| | - Konstantinos C. Fragkos
- 0000000121901201grid.83440.3bDepartment of Medical Statistics, University College London, London, UK
| | - David Lawrence
- 0000 0004 0612 2754grid.439749.4Department of Thoracic Surgery, University College London Hospital, London, UK
| | - Jeremy George
- 0000 0004 0612 2754grid.439749.4Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Borzoueh Mohammadi
- 0000 0004 0612 2754grid.439749.4Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU UK
| | - Khaled Dawas
- 0000 0004 0612 2754grid.439749.4Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU UK
| | - Helen Booth
- 0000 0004 0612 2754grid.439749.4Department of Thoracic Medicine, University College London Hospital, London, UK
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Facciorusso A, Muscatiello N. Submucosal Injection Solutions for Colon Polypectomy. COLON POLYPECTOMY 2018:89-106. [DOI: 10.1007/978-3-319-59457-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Double stenting for malignant oesophago-respiratory fistula. Wideochir Inne Tech Maloinwazyjne 2016; 11:214-221. [PMID: 27829946 PMCID: PMC5095274 DOI: 10.5114/wiitm.2016.62042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/22/2016] [Indexed: 01/05/2023] Open
Abstract
Introduction The close anatomical relationship between the oesophagus and bronchial tree results in formation of an oesophago-respiratory fistula in a subset of patients with advanced oesophageal or lung cancer. In those patients stenting of both the oesophagus and tracheobronchial tree is a valid option of palliative treatment. Aim To determine the effectiveness, tolerance, quality of life, safety and survival after double stenting procedures. Material and methods Retrospective analysis of a prospectively collected database was performed, concerning consecutive patients with oesophago-respiratory fistulas treated with double stenting. In all patients the degree of dysphagia, respiratory function before and after the procedure, and quality of life were evaluated. Partially covered oesophageal self-expanding metallic stents (PCESEMS) were used for oesophageal stenting, and silicone Y-type or partially covered self-expanding bronchial and tracheal stents (PCASEMS) were used to restore airway patency. Results Between 2003 and 2015, 31 patients underwent double stenting due to oesophago-respiratory fistulas. Twenty-nine patients were diagnosed with oesophageal squamous cell carcinoma and 2 with bronchial carcinoma. In all patients, improvement in the general condition and quality of life was observed after airway patency restoration. Two patients required mechanical ventilation due to respiratory failure immediately after the procedure. Seven patients with oesophageal fistulas died because of bleeding in the long-term follow-up. Four patients required endoscopic re-intervention. Mean survival time was 67.1 days. Conclusions Double stenting is an effective procedure improving patients’ quality of life. However, life-threatening complications can occur.
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Liu YH, Ko PJ, Wu YC, Liu HP, Tsai YH. Silicone Airway Stent for Treating Benign Tracheoesophageal Fistula. Asian Cardiovasc Thorac Ann 2016; 13:178-80. [PMID: 15905351 DOI: 10.1177/021849230501300218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We used a silicone tracheal stent successfully to seal a huge benign tracheoesophageal fistula and restore airway patency after treatment with double metallic stenting of the trachea and esophagus failed. The patient was weaned from the ventilator 16 days after the procedure and after 7 months of ventilatory support.
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Affiliation(s)
- Yun-Hen Liu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
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Nakajima Y, Kawada K, Tokairin Y, Miyawaki Y, Okada T, Miyake S, Kawano T. Retrospective Analyses of Esophageal Bypass Surgery for Patients with Esophagorespiratory Fistulas Caused by Esophageal Carcinomas. World J Surg 2016; 40:1158-64. [DOI: 10.1007/s00268-015-3391-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hamer PW, Griffiths EA, Devitt PG. Tracheo-oesophageal fistula after palliative treatment of oesophageal cancer. J Gastrointest Oncol 2015; 6:E86-8. [PMID: 26487957 DOI: 10.3978/j.issn.2078-6891.2015.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a case of an 86-year-old male who presented with severe pneumonia in the context of having undergone radiotherapy and then an oesophageal stent insertion for palliation of oesophageal cancer. He was diagnosed with a tracheo-oesophageal fistula (TOF) which was successfully managed by deploying a second stent within the first stent.
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Affiliation(s)
- Peter W Hamer
- Professorial and Oesophagogastric Surgery, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Ewen A Griffiths
- Professorial and Oesophagogastric Surgery, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter G Devitt
- Professorial and Oesophagogastric Surgery, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
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Kazakov J, Khereba M, Thiffault V, Duranceau A, Ferraro P, Liberman M. Modified technique for tracheobronchial Y-stent insertion using flexible bronchoscope for stent guidance. J Thorac Cardiovasc Surg 2015; 150:1005-9. [DOI: 10.1016/j.jtcvs.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/24/2015] [Accepted: 07/03/2015] [Indexed: 12/17/2022]
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Zori AG, Jantz MA, Forsmark CE, Wagh MS. Simultaneous dual scope endotherapy of esophago-airway fistulas and obstructions. Dis Esophagus 2014; 27:428-434. [PMID: 23937203 DOI: 10.1111/dote.12120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of esophago-airway fistulas (EAF) and obstructions often involves therapy with esophageal and/or airway stents. We present a unique approach for the management of EAF and obstructions with simultaneous upper endoscopy and bronchoscopy (two scopes inserted simultaneously through the mouth). The aim is to assess the efficacy and safety of a simultaneous dual scope approach for management of EAF and obstructions. The endoscopy database at the University of Florida was reviewed from October 2007 to April 2012 to identify adult patients who had undergone simultaneous upper endoscopy and bronchoscopy for EAF and obstructions. Medical records were reviewed for demographics, indication, pathology, imaging, simultaneous endoscopic and bronchoscopic findings/maneuvers, outcomes, and adverse events. Outcomes assessed included: (i) technical success, (ii) fistula occlusion, (iii) dysphagia score, and (iv) adverse events. Thirteen patients with EAF and/or obstruction underwent simultaneous dual scope endoscopy. Dual scope procedures were technically successful in 12/13 (92%) patients. Dysphagia score improved from three to one in both patients with dysphagia without EAF. Fistula occlusion was observed in 7/10 patients (70%) with EAF. With this technique, stents were placed accurately without airway compression, migrated esophageal stents extracted from the tracheal lumen without trauma, and tracheal stents not displaced during esophageal manipulations. EAF not otherwise apparent were identified in two patients. Adverse events occurred in 2/13 (15%) patients, and 5/13 (38%) patients died from advanced cancer during follow up (mean 4.1 months, range 1-8 months). Simultaneous dual scope (two scopes inserted through the mouth at the same time) therapy of EAF and obstructions is feasible, effective, and safe, and may develop to be the preferred approach for the management of complex esophago-airway diseases.
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Affiliation(s)
- A G Zori
- Division of Gastroenterology, University of Florida, Gainesville, Florida, USA
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Freire JP, Almeida JCMD. Review of (acquired) incidental, rare and difficult tracheoesophageal fistula management. World J Surg Proced 2014; 4:9-12. [DOI: 10.5412/wjsp.v4.i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/24/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Acquired benign tracheoesophageal fistula is a rare condition and a difficult problem. The rarity and unpredictable presentation of this condition makes the design and setting of randomized prospective trials impossible. Guidelines on this matter are also difficult to establish. Based on a comprehensive evaluation of published literature and their experience, the authors review the etiology and best options for treatment, either surgical and non surgical, according to present knowledge.
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Schweigert M, Posada-González M, Dubecz A, Ofner D, Muschweck H, Stein HJ. Recurrent oesophageal cancer complicated by tracheo-oesophageal fistula: improved palliation by means of parallel tracheal and oesophageal stenting. Interact Cardiovasc Thorac Surg 2013; 18:190-6. [PMID: 24170746 DOI: 10.1093/icvts/ivt466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Recurrent oesophageal carcinoma complicated by the development of a tracheo-oesophageal fistula is a crushing condition. In this situation, endoscopic double stenting may provide a quick and safe option for palliation. METHODS The outcomes of patients who received endoscopic parallel stent implantation for tracheo-oesophageal fistula due to recurrent oesophageal cancer at a German tertiary referral hospital between 2006 and 2013 were reviewed in a retrospective case study. RESULTS A total of 9 patients were identified (mean age 59.9 years). Tumour entity was squamous cell carcinoma, adenocarcinoma and neuroendocrine cancer of the oesophagus in 5, 3 and 1 case, respectively. The mean interval between primary treatment and recurrence was 19.2 months. Successful double-stent placement was always feasible. Complete closure of the communication between oesophagus and respiratory system was accomplished in all cases by stent implantation. There were no stent-associated complications. The mean survival following stent insertion was 64 days (6-121 days). After successful double stenting, 5 patients were fit enough to receive palliative chemo- or radiotherapy. Seven patients were finally discharged home after adequate oral intake had been achieved. Fatal aspiration pneumonia with respiratory failure occurred in 2 cases. CONCLUSIONS Endoscopic parallel stent implantation provides an easy and ubiquitous available technique for closure and palliation of tracheo-oesophageal fistula caused by recurrent oesophageal cancer. Immediate sealing of the fistula and relief of symptoms related to aspiration is achieved while hazardous operations are avoided. Therefore, we recommend endoscopic parallel stent insertion as the treatment of choice in case of tracheo-oesophageal fistula caused by recurrent oesophageal cancer.
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Affiliation(s)
- Michael Schweigert
- Department of General and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany
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Alraiyes AH, Desai R, Auron M, Castillo MD, Alraies MC. Bronchoesophageal fistula secondary to broncholith. QJM 2013; 106:959-60. [PMID: 22927537 DOI: 10.1093/qjmed/hcs170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Varadarajulu S, Banerjee S, Barth B, Desilets D, Kaul V, Kethu S, Pedrosa M, Pfau P, Tokar J, Wang A, Song LMWK, Rodriguez S. Enteral stents. Gastrointest Endosc 2011; 74:455-64. [PMID: 21762904 DOI: 10.1016/j.gie.2011.04.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 02/08/2023]
Abstract
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2010 for articles related to enteral, esophageal, duodenal, and colonic stents. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
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Abstract
Advancements in the surgical and medical treatment of lung cancer have resulted in more favorable short-term survival outcomes. After initial treatment, lung cancer requires continued surveillance and follow-up for long-term side effects and possible recurrence. The integration of quality palliative care into routine clinical care of patients with lung cancer after surgical intervention is essential in preserving function and optimizing quality of life through survivorship. An interdisciplinary palliative care model can effectively link patients to the appropriate supportive care services in a timely fashion. This article describes the role of palliative care for patients with lung cancer.
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Affiliation(s)
- Betty Ferrell
- Department of Population Sciences, Nursing Research and Education, City of Hope, Duarte, CA 91010, USA.
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21
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Esophageal strictures, tumors, and fistulae: stents for primary esophageal cancer. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2011.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Shin JH, Kim JH, Song HY. Interventional management of esophagorespiratory fistula. Korean J Radiol 2010; 11:133-140. [PMID: 20191059 PMCID: PMC2827775 DOI: 10.3348/kjr.2010.11.2.133] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 11/20/2009] [Indexed: 11/15/2022] Open
Abstract
An esophagorespiratory fistula (ERF) is an often fatal consequence of esophageal or bronchogenic carcinomas. The preferred treatment is placement of esophageal and/or airway stents. Stent placement must be performed as quickly as possible since patients with ERFs are at a high risk for aspiration pneumonia. In this review, choice of stents and stenting area, fistula reopening and its management, and the long-term outcome in the interventional management of malignant ERFs are considered. Lastly, a review of esophagopulmonary fistulas will also be provided.
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Affiliation(s)
- Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Jin-Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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Turkyilmaz A, Aydin Y, Eroglu A, Bilen Y, Karaoglanoglu N. Palliative management of esophagorespiratory fistula in esophageal malignancy. Surg Laparosc Endosc Percutan Tech 2009; 19:364-367. [PMID: 19851261 DOI: 10.1097/sle.0b013e3181ba796d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Esophagorespiratory fistula (ERF) is a complication of an esophageal malignancy that has serious effects on the mortality of a patient, whose survival is limited to weeks. Sealing of fistula and recovery of swallowing has greater importance than treating underlying primary malignancy. In this study, we aimed to present our clinic experience in patients with ERF and to discuss the findings together with the literature. MATERIALS AND METHODS Between January 2003 and December 2008, 326 patients with malignant esophageal disorder were admitted to our clinic, and ERF detected in 18 (5.5%) patients. There were 10 men and 8 women with a mean age of 54.7+/-11.9 years (range: 34 to 75 y). Metastases in the lung and liver were detected in 4 and 2 patients, respectively. Empyema was found in 3 of the ERF patients. Pneumonic infiltration was detected via radiologic evaluation in 7 (38.9%) of the 18 patients. Two patients did not accept any intervention. A feeding gastrostomy tube was placed in 2 other patients. Fluoroscopy-guided Ultraflex esophageal stent placement was applied to the remaining 14 patients. Eleven (78.6%) patients underwent stent placements during generalized anesthesia via rigid esophagoscopy, and the remaining 3 (21.4%)patients via flexible esophagoscopy with sedation. RESULTS One of the patients who did not accept intervention died after 2 weeks, and the other died 6 weeks after admission. One of the patients who received a feeding gastrostomy tube died 17 weeks after admission, and the other was still alive after a month, when this article was written. Closure of the ERF was seen in all 14 patients who underwent palliative covered self-expandable metallic stent placement in the esophagus. No complications occurred in the stent-placed patients either during or after the procedure. Dyspeptic complaints and pain were treated successfully with medical therapy in 6 and 5 patients, respectively. Symptoms of aspiration disappeared after stent placement. No reopened fistulae were observed during follow-up. Thirteen of the 14 stent-replaced patients died during follow-up. The mean survival rate for these 13 patients was 11.2 weeks (range: 1 to 49 wk). The mean length of hospital stay after stent placement in the 14 patients was 3.7 days (1 to 15 d). DISCUSSION Covered self-expandable metallic stent placement in malign ERF patients is a technically simple and safer method for fistula closure and seems to be the most effective method that is easily available.
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Affiliation(s)
- Atila Turkyilmaz
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
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Moon E, Gillespie CT, Vachani A. Pulmonary complications of inflammatory bowel disease: focus on management issues. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2009. [DOI: 10.1016/j.tgie.2009.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lindenmann J, Neuboeck N, Anegg U, Matzi V, Maier A, Smolle-Juettner FM. Self-Expanding Bifurcation Stent for Malignant Esophagotracheobronchial Fistula. Asian Cardiovasc Thorac Ann 2009; 17:79-81. [DOI: 10.1177/0218492309102527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 60-year-old man with esophageal carcinoma in the upper 3rd underwent palliative treatment including photodynamic therapy, brachytherapy, external beam irradiation, and esophageal stenting. He developed a symptomatic malignant esophagotracheobronchial fistula that could not be closed by telescope-stenting in the esophagus. Implantation of a self-expanding, covered metal, tracheal bifurcation stent by flexible bronchoscopy resulted in immediate closure of the fistula with an uneventful recovery.
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Affiliation(s)
- Joerg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | - Nicole Neuboeck
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | - Udo Anegg
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | - Veronika Matzi
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | - Alfred Maier
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
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Endoscopic Approach to Tracheoesophageal Fistulas in Adults. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2008. [DOI: 10.1016/j.tgie.2008.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Paganin F, Schouler L, Cuissard L, Noel JB, Becquart JP, Besnard M, Verdier L, Rousseau D, Arvin-Berod C, Bourdin A. Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement. PLoS One 2008; 3:e3101. [PMID: 18769726 PMCID: PMC2518104 DOI: 10.1371/journal.pone.0003101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 07/23/2008] [Indexed: 11/28/2022] Open
Abstract
Background Most inoperable patients with esophageal-advanced cancer (EGC) have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. Methods and Findings The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58±\−8 years of age) with esophageal stenting indication were investigated. Seven patients (group 1) were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression). Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2): stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication). Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/−10 weeks and was significantly shorter in group 1 (6+/−7.6 weeks) than in group 2 (28+/−11 weeks), p<0.001). Scheduled double stenting significantly improved symptoms (95% at day 7) with a low complication rate (13%), and achieved a specific cancer treatment (84%) in most cases. Conclusion Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased airways complications related to esophageal stent. Emergency procedures were rarely efficient in our experience.
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Van Natta TL, Parekh KR, Reed CG, Shebrain SA, Omari BO. Benign esophagobronchial fistula with and without esophageal obstruction: two ends of the surgical spectrum. Ann Thorac Surg 2008; 85:322-325. [PMID: 18154838 DOI: 10.1016/j.athoracsur.2007.07.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 07/19/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
Abstract
Acquired esophagobronchial fistula (EBF) is uncommon and its surgical remediation is challenging. Management depends on the cause, degree of pulmonary involvement, and existence of esophageal obstruction. We report management of two EBF cases representing extremes of the surgical spectrum. One patient with EBF secondary to mediastinal fungal infection underwent pulmonary resection and esophageal repair. Another, who was positive for human immunodeficiency virus, required esophageal resection and fistula closure, but no pulmonary resection. Successful outcome was achieved in both patients.
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Affiliation(s)
- Timothy L Van Natta
- Division of Cardiothoracic Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
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Kvale PA, Selecky PA, Prakash UBS. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:368S-403S. [PMID: 17873181 DOI: 10.1378/chest.07-1391] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED GOALS/OBJECTIVES: To review the scientific evidence on symptoms and specific complications that are associated with lung cancer, and the methods available to palliate those symptoms and complications. METHODS MEDLINE literature review (through March 2006) for all studies published in the English language, including case series and case reports, since 1966 using the following medical subject heading terms: bone metastases; brain metastases; cough; dyspnea; electrocautery; hemoptysis; interventional bronchoscopy; laser; pain management; pleural effusions; spinal cord metastases; superior vena cava syndrome; and tracheoesophageal fistula. RESULTS Pulmonary symptoms that may require palliation in patients who have lung cancer include those caused by the primary cancer itself (dyspnea, wheezing, cough, hemoptysis, chest pain), or locoregional metastases within the thorax (superior vena cava syndrome, tracheoesophageal fistula, pleural effusions, ribs, and pleura). Respiratory symptoms can also result from complications of lung cancer treatment or from comorbid conditions. Constitutional symptoms are common and require attention and care. Symptoms referable to distant extrathoracic metastases to bone, brain, spinal cord, and liver pose additional problems that require a specific response for optimal symptom control. There are excellent scientific data regarding the management of many of these issues, with lesser evidence from case series or expert opinion on other aspects of providing palliative care for lung cancer patients. CONCLUSIONS Palliation of symptoms and complications in lung cancer patients is possible, and physicians who provide such care must be knowledgeable about these issues.
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Affiliation(s)
- Paul A Kvale
- Division of Pulmonary, Critical Care, Allergy, Immunology, and Sleep Disorders Medicine, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA.
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Murthy S, Gonzalez-Stawinski GV, Rozas MS, Gildea TR, Dumot JA. Palliation of malignant aerodigestive fistulae with self-expanding metallic stents. Dis Esophagus 2007; 20:386-9. [PMID: 17760651 DOI: 10.1111/j.1442-2050.2007.00689.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Malignant aerodigestive fistulae are rare but devastating sequelae of thoracic cancers, most commonly associated with esophageal cancer. Survival following development of a malignant aerodigestive fistula is measured in weeks. Palliation is the primary goal of therapy and to this end, we report the use of self-expanding metallic stents (SEMS) as treatment. Between May 1999 and January 2004, 12 patients were treated for malignant aerodigestive fistulae. The underlying diagnosis was esophageal cancer for 10 patients, and non-small cell lung cancer for two others. All patients were symptomatic and fistulae were diagnosed by esophagoscopy in seven, bronchoscopy in two, and esophagram in three. Seven covered Wallstents (seven esophageal) and eight covered Ultraflex (five tracheal and three esophageal) were used. A single stent was placed in eight patients (seven esophageal and one tracheal). Three patients required esophageal and tracheal stents and one patient needed two tracheal stents. General anesthesia was required in 50% of the patients. There were no procedure-related complications. Symptoms were palliated in 100% of patients and oral intake was reinstituted in 42% (5/12). All the patients were discharged from hospital after SEMS placement and one patient returned for an uneventful tracheal stent replacement secondary to mucus impaction 2 months later. SEMS placement is an effective strategy to palliate malignant aerodigestive fistulae. Complications are rare and symptoms are alleviated in most patients.
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Affiliation(s)
- S Murthy
- Center for Major Airway Diseases, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Lecleire S, Antonietti M, Di Fiore F, Ben-Soussan E, Bota S, Hellot MF, Thiberville L, Michel P, Lerebours E, Ducrotté P. Double stenting of oesophagus and airways in palliative treatment of patients with oesophageal cancer is efficient but associated with a high morbidity. Aliment Pharmacol Ther 2007; 25:955-63. [PMID: 17403000 DOI: 10.1111/j.1365-2036.2007.03280.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Double stenting of oesophagus and airways may be required in palliative treatment of patients with locally advanced oesophageal cancer. AIM To assess feasibility, efficacy and complications occurring in patients with locally advanced oesophageal cancer receiving both oesophagus and airways stenting. METHODS In one single centre between 1997 and 2005, among 180 patients with locally advanced oesophageal cancer treated by the palliative placement of a self-expanding metal stent, patients requiring double stenting of oesophagus and airways were identified. Clinical efficacy, complications and survival were retrospectively collected. RESULTS Fifteen patients (8.3% of 180) required a double stenting at follow-up. Symptomatic efficacy of oesophagus and airways stenting was 86.7% for dysphagia and 100% for dyspnoea. Median survival after the second stent insertion was 99 days. Life-threatening early complications occurred in three patients after double stenting (20%), including two deaths following oesophageal perforation and massive haemoptysis, respectively. Procedure-related mortality was 13.3%. CONCLUSIONS Double stenting of oesophagus and airways is feasible in patients with locally advanced oesophageal cancer, with a relevant clinical efficacy. However, early major complications including procedure-related death may occur in as many as 20% of patients. This treatment should be reserved to very selected patients with severe symptoms and end-stage disease.
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Affiliation(s)
- S Lecleire
- Department of Hepato-Gastroenterology and Nutrition, Rouen University Hospital & ADEN-EA3234/IFRMP23, Institute for Biomedical Research, Rouen, France.
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Lindenmann J, Porubsky C, Matzi V, Maier A, Smolle-Juettner FM. Inherent Problems of Tracheo-Bronchial Stenting in Patients With Tracheostomy. Ann Thorac Surg 2006; 82:1897-8. [PMID: 17062272 DOI: 10.1016/j.athoracsur.2006.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 03/09/2006] [Accepted: 03/13/2006] [Indexed: 11/23/2022]
Abstract
In cases of permanent tracheostomy after laryngectomy, tracheo-bronchial stenting may cause serious respiratory problems due to the absence of airway humidification and the inability to cough forcefully. We report 2 patients with permanent tracheostomy who underwent stenting and developed recurrent episodes of asphyxia due to stent obstruction by dried mucus. The indication for stenting of the airways must be established with great care in patients with permanent tracheostomy.
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Affiliation(s)
- Joerg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, University Medical School, Graz, Austria.
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Tierney W, Chuttani R, Croffie J, DiSario J, Liu J, Mishkin DS, Shah R, Somogyi L, Petersen BT. Enteral stents. Gastrointest Endosc 2006; 63:920-6. [PMID: 16733104 DOI: 10.1016/j.gie.2006.01.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Over the past 5 years, new developments in the palliative treatment of incurable cancer of the oesophagus and gastro-oesophageal junction have been introduced with the aim of palliating dysphagia and improving the survival of patients. Stent placement is currently the most widely used treatment for palliation of dysphagia from oesophageal cancer. A stent offers rapid relief of dysphagia; however, current recurrent dysphagia rates vary between 30 and 40%. Recently introduced new stent designs are likely to reduce recurrent dysphagia by decreasing stent migration and non-tumoral tissue overgrowth. Intraluminal radiotherapy (brachytherapy) has been demonstrated to compare favourably with stent placement in long-term effectiveness and safety. A disadvantage of brachytherapy, however, is that one-fifth of patients need an additional treatment because of persistent tumour growth in the oesophagus. A solution may be to administer brachytherapy not in a single fraction but in multiple fractions. Finally, efforts have been undertaken to improve survival of patients by using chemotherapy. In the future, a multimodal approach--for example by combining stent placement with chemotherapy or radiotherapy--may improve the prognosis of patients without jeopardizing their quality of life.
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Affiliation(s)
- Peter D Siersema
- Chief of Endoscopy, Head of the Gastrointestinal Oncology Program Department of Gastroenterology and Hepatology, Room Hs-512, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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New Cufflink-Shaped Silicon Prosthesis for the Palliation of Malignant Tracheobronchial-Esophageal Fistula. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/01.lab.0000186344.07897.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eleftheriadis E, Kotzampassi K. Temporary stenting of acquired benign tracheoesophageal fistulas in critically ill ventilated patients. Surg Endosc 2005; 19:811-815. [PMID: 15868255 DOI: 10.1007/s00464-004-9137-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 11/13/2004] [Indexed: 12/13/2022]
Abstract
BACKGROUND To evaluate the use of esophageal stents for temporary sealing of acquired benign tracheoesophageal fistulas developed in critically ill, ventilated patients. METHODS This is a retrospective analysis (1992-2003) of the data of 12 mechanically ventilated patients - six of them after major or multiple trauma - being intubated for a median of 30 days before they develop an acquired benign tracheoesophageal fistula. Five of them were in sepsis. Two types of stents were used: the Wilson-Cook esophageal balloon plastic stent in the first four cases and the Ultraflex covered self-expandable stent in the remaining eight. The total procedure was performed at bedside in the intensive care unit, with no special need for supplementary anesthesia or fluoroscopic control. RESULTS Stent implantation was technically successful in all patients and fistula occlusion was achieved in every case. There was no stent migration and fistulas remained sealed until death or upon decision for removal. Nine patients died between 5 days and 2 months after stent placement, as a result of their diseases. Three patients were referred for fistula surgical repair 33, 36, and 43 days after stent placement. Before surgery the stents were easily removed under direct vision. CONCLUSION Temporary closure of an acquired tracheoesophageal fistula developed in critically ill ventilated patients is an easy, bedside-applicable, safe, and effective palliative procedure, with no complications or mortality.
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Affiliation(s)
- E Eleftheriadis
- Department of Surgery, University of Thessaloniki Medical School, Thessaloniki, Greece.
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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; 232:252-9. [PMID: 15166325 DOI: 10.1148/radiol.2321030733] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate long-term clinical results of palliative treatment of esophagorespiratory fistulas (ERFs) with covered expandable metallic stents. MATERIALS AND METHODS Sixty patients with ERFs due to esophageal or bronchogenic carcinoma and one patient with ERF due to pressure necrosis caused by initial esophageal stent placement for esophageal carcinoma were treated with covered expandable esophageal or tracheobronchial metallic stents. Information about technical success of stent placement, initial clinical success and failure, fistula reopening, and complications was obtained. Survival curves for both patient groups with initial clinical success and failure were obtained and compared with Kaplan-Meier methods and log-rank test. RESULTS Stent placement was technically successful in all patients, with no immediate procedural complications. The stent completely sealed off the fistula in 49 (80%) of 61 patients so that they had no further aspiration symptoms (initial clinical success). Twelve (20%) of 61 patients had persistent aspiration symptoms due to incomplete ERF closure (initial clinical failure). During follow-up, the fistula reopened in 17 (35%) of 49 patients with initial clinical success: In eight patients, the reopened ERF was sealed off successfully with stent placement or balloon dilation. In two patients with reopened ERF caused by food impaction, the reopened fistula resolved spontaneously. Seven patients did not undergo further treatment. All patients died during follow-up, and mean survival was 13.4 weeks (range, 1-56 weeks) after stent placement. Mean survival in patients with initial clinical success was significantly longer than that in patients with initial clinical failure (15.1 vs 6.2 weeks, P <.05). CONCLUSION Covered expandable metallic stents were placed in 61 patients with ERFs, but the initial clinical success rate was poor and the rate of reopening was high; however, interventional treatment was effective for sealing off reopened ERFs.
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Affiliation(s)
- Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, Korea
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Abstract
While medical therapy, particularly with proton pump inhibitors, is effective for the large majority of patients with reflux disease, there remains a subset of patients who are dissatisfied, due to cost, side effects of medications, or persistent symptoms such as regurgitation. For this population, surgical fundoplication has been, and remains, an appropriate option. A new class of endoluminal interventions, attempting to create a mechanical antireflux barrier, has emerged recently. Three such devices are currently approved and available, and a number of others are in various stages of evaluation. This article will review the approved technologies, as well as selected promising emerging ones. with particular emphasis on the scientific evidence available to date supporting their efficacy.
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Affiliation(s)
- Brian W Behm
- East Bay Center for Digestive Health, 3300 Webster Street, Suite 312, Oakland, CA 94609, USA
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Chauhan SS, Long JD. Management of Tracheoesophageal Fistulas in Adults. ACTA ACUST UNITED AC 2004; 7:31-40. [PMID: 14723836 DOI: 10.1007/s11938-004-0023-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The approach to treatment of adult patients with tracheoesophageal fistulas depends on whether the fistula is congenital or acquired in origin. Most adults have acquired tracheoesophageal fistulas, and treatment depends on whether the fistula is a result of a benign process or a malignancy, with the latter usually primary esophageal cancer. For patients with benign tracheoesophageal fistulas, treatment is almost always initially supportive followed by definitive surgical correction. In general, depending on the size and location of the tracheal aspect of the fistula, surgical therapy involves primary repair of the fistula and, if necessary, resection and reconstruction of the trachea. For patients with malignant tracheoesophageal fistulas, treatment depends on whether the patient is resectable and/or medically fit for surgical therapy. However, most patients with malignant trach-eoesophageal fistulas have advanced disease and can only be treated with palliative measures. The current standard of palliative therapy for patients with malignant tracheoesophageal fistulas is the endoscopic or radiologic placement of covered self-expanding metallic stents (SEMS), which allow closure of the fistula. All three types of commercially available covered SEMS have been used in this capacity with success. Other, less common treatment options for selected patients with malignant tracheoesophageal fistulas include chemotherapy and radiation, surgical bypass, esophageal exclusion, and fistula resection and repair.
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Affiliation(s)
- Shailendra S. Chauhan
- Division of GI/Hepatology/Nutrition, VCU Health System, PO Box 980341, 1200 East Broad Street, Richmond, VA 23298, USA.
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Schembre DB. Endoscopic therapeutic esophageal interventions: old, new, borrowed and . . . methylene blue? Curr Opin Gastroenterol 2003; 19:394-9. [PMID: 15703583 DOI: 10.1097/00001574-200307000-00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Endoscopic interventions in the esophagus continue to evolve. This article reviews some of the notable advances over the past year in endoscopic therapy for the esophagus. RECENT FINDINGS In 2002 several endoscopic therapies were reintroduced or modified. Ablative treatments, including Nd:YAG laser, photodynamic therapy, and thermal contact treatments have been shown to be effective for Barrett esophagus and some early esophageal cancers. The addition of endoscopic mucosal resection may improve these therapies. Endoscopic stenting remains the dominant endoscopic palliative modality for unresectable esophageal cancers, and modifications of this therapy have focused on reducing side effects and complications. Innovations in endoscopic treatments for strictures and bleeding esophageal varices have been proposed and may improve outcomes, although probably only marginally. Additional endoscopic antireflux procedures have been introduced, although the results of long-term studies still need to be published before their place in the treatment of gastroesophageal reflux disease can be determined. SUMMARY Rather than heralding novel endoscopic therapeutics, 2002 was a year of retooling and refining existing techniques.
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Affiliation(s)
- Drew B Schembre
- University of Washington, Virginia Mason Medical Center, Seattle, Washington, USA.
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Fan AC, Baron TH, Utz JP. Combined tracheal and esophageal stenting for palliation of tracheoesophageal symptoms from mediastinal lymphoma. Mayo Clin Proc 2002; 77:1347-50. [PMID: 12479523 DOI: 10.4065/77.12.1347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mediastinal lymphoma as a cause of tracheobronchial obstruction is uncommon, and a malignant tracheoesophageal fistula in the setting of mediastinal lymphoma is rare. Malignant tracheoesophageal fistulas are associated with pronounced morbidity and mortality. We describe a patient with mediastinal lymphomatous infiltration resulting in tracheal obstruction, esophageal obstruction, and tracheoesophageal fistula that were successfully palliated with combined airway and esophageal stent placement.
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Affiliation(s)
- Andy C Fan
- Department of Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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