Palliative Tracheal and Esophageal Double Stenting for Tracheoesophageal Fistula

Abstract

Purpose: Malignant tracheoesophageal fistula is a relatively rare condition that results in serious morbidity and mortality due to recurrent aspiration, sepsis, and death. We describe herein the use of combined tracheal and esophageal stenting for palliative care. A 58 y.o. veteran with a history of COPD and NSC lung cancer, (stage IIIB of the left lung) with a lingular cavitary lesion was evaluated for increased dyspnea and inability to handle secretions. CT scan revealed tracheoesophageal fistula connecting the left main bronchus and mid-esophagus. Following a detailed discussion with the patient, a combined tracheal and esophageal stenting to correct the defect was planned. The patient first underwent successful placement of a 13 mm Boston Scientific Dynamic Y™ stent into the trachea and main bronchi. Unfortunately, the Y stent was not long enough to extend past the fistulous opening in the left main bronchus by 0.5 cm as would be ideal. The patient recovered from the procedure uneventfully. Two days later he underwent successful placement of a Wilson-Cook Evolution™ 20-25-10 stent into the esophagus which completely sealed the 3 cm defect. The patient tolerated the second procedure well with significant improvement in his symptoms. This case highlights the palliative role combined tracheal and esophageal stenting can have in patients with malignant tracheoesophageal fistula. Careful selection and meticulous technique are crucial to the success of the procedure and go a long way towards improving patients' quality of life.Figure