TREATMENT OF ESOPHAGEAL FISTULAS WITH A NEW POLYURETHANE-COVERED, SELF-EXPANDING MESH STENT - A PROSPECTIVE-STUDY

Objectives: Esophagorespiratory fistulas are serious complications of malignant disease in the esophagus and are associated with rapid deter ioration and death. Palliation has thus far consisted of insertion of a plastic stent to occlude the fistula opening. Insertion of these ste nts is associated with a high complication rate. Our aims were to stud y the efficacy of a new class of metal stents covered with a membrane with regard to fistula occlusion and lumen patency. Methods: Six conse cutive patients with esophagorespiratory fistulas were treated with co vered expandable metal stents. Results: In all six patients, no eviden ce of persisting fistula was seen on contrast radiographs 2 h after st ent placement. All patients were able to eat a normal diet after stent insertion and had complete occlusion of their esophagorespiratory fis tula. One patient reported pain after the procedure, and the symptoms persisted until death. One patient died of massive hematemesis 5 days after the procedure. Dysphagia scores improved in all patients from a median of 4 to a median of 1, and the Karnofsky score improved from a median of 40% to a median of 65%. Fistulas remained closed until death in all patients. Conclusions: Covered expandable metal stents are saf e and effective in the palliation of esophagorespiratory fistulas.