Management of digestive-respiratory fistulae (DRF) with coated expandable esophageal stents (cEES)

DRF complicating esophageal-mediastinal malignancies or their treatment are uncommon. While effective, plastic stents are associated with increased morbidity and mortality. EES have become the preferred palliative treatment for malignant dysphagia, but their lack of coating precludes their use in DRF. cEES offer the advantages of EES and the sealing of the DRF offered by plastic stents. We report our experience with cEES Wallstent (Schneider, Minneapolis) in 12 pts with DRF. There were 4 W, 8 M, mean age 52 years (range 25-77). Two had respiratory insufficiency requiring intubation. Placement of the cEES was successful in all pts. Nine pts had esophageal CA, 2 lung CA, 1 lymphoma. The tumor was exophytic in 10. The lesion was proximal in 3, midesophageal in 7, and distal in 2. Eleven had associated stricture, mean length 4.8 cms. Esophageal dilation was required in 8 pts. There were no complications related to the procedure. Barium swallow showed healing of the DRF in all pts. After a mean follow-up of 271 days (range 30-400), 7 pts died of tumor progression between 1 and 16 months after cEES placement without recurrent dysphagia or DRF symptoms. Percutaneous gastrostomies were required for persistent dysphagia in 1 and continued respiratory intubation for severe pneumonia in 1. In the latter, the gastrostomy was removed 2 months later with the patient being able to eat semisolids. There was no stent-related morbidity or mortality. In conclusion, coated Wallstents offer excellent palliation of DRF and associated dysphagia without related procedural or stent related morbidity or mortality.