Open AccessTechnical Difficulties and Procedural Complications in Closing Malignant Esophageal-Respiratory Fistulas
Author(s) -
Andrei Cozorici,
Vlad Porumb,
Sorinel Luncă,
Ioana Grigoraș,
Irina Ristescu,
I Jitaru,
Emilia Pătrășcanu,
Laura Gavril,
Gabriel Dimofte
Publication year - 2021
Publication title -
acta clinica croatica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.274
H-Index - 20
eISSN - 1333-9451
pISSN - 0353-9466
DOI - 10.20471/acc.2021.60.04.18
Subject(s) - medicine , dysphagia , surgery , fistula , esophageal cancer , gastrostomy , esophagus , intubation , cancer
The aim of the study was to outline technical difficulties and procedural complications of using partially covered esophageal self-expandable metal stents (SEMSs) in malignant esophageal respiratory fistulas (ERFs) as a palliative treatment option. In this study, 150 patients with malignant dysphagia underwent treatment with SEMSs. A total of 36 ERFs were detected through endoscopic or clinical assessment. Complete fistula sealing with SEMSs was possible in 35 of the 36 patients. The majority of fistulas were diagnosed in male patients with advanced esophageal cancer. All of them presented with prolonged dysphagia and cachexia. Stent migration or tumoral overgrowth was identified in 6 cases with recurrent dysphagia, and required a second stent insertion. SEMSs were highly efficient in 98% of the patients studied with ERFs, with successfully sealed ERFs after the first attempt, with an overall median survival rate of 92 days. The technique of esophageal SEMS placement is simple and can be rapidly mastered. Patients with ERFs have a respiratory shunt that makes intubation difficult and is often avoided. Restoring oral feeding increased the patient quality of life. SEMS placement is generally safe, but has few associated postoperative complications.