The role of parallel stent insertion in patients with esophagorespiratory fistulas

Abstract

Background: Patients with malignant esophagorespiratory fistulas have a poor prognosis. Treatment is palliative and involves restoration of the ability to ingest food and prevention of aspiration by insertion of esophageal or tracheobronchial stents. Because insertion of a single stent may be insufficient for palliation, a series of patients who underwent parallel stent insertion were studied. Methods: Thirteen patients with esophagorespiratory fistulas who required parallel stents were studied retrospectively. Palliation was evaluated by assessing dyspnea, dysphagia, and coughing associated with eating and/or drinking before and after insertion of stents. Observations: Insertion of the first stent (n = 13) resulted in complete relief of symptoms attributed to an esophagorespiratory fistula in 46% and in a reduction in symptoms in 54% of patients. The interval between insertion of the first and second stents ranged from 1 to 182 days (mean 46 days). Insertion of the second stent (n = 12) resulted in complete relief of symptoms in 42% and a reduction in symptoms in 58% of the patients. Conclusion: Parallel stent insertion may be indicated in patients with symptoms caused by malignant esophagorespiratory fistula.