MANAGEMENT OF MALIGNANT ESOPHAGOTRACHEAL FISTULAS WITH AIRWAY STENTING AND DOUBLE STENTING

Prognosis of inoperable or recurrent esophageal carcinoma is, at best, poor, Once an esophagotracheal fistula has developed, the overall con dition of the patient declines rapidly. Aspiration pneumonia and sever e coughing are common. The introduction of esophageal tubes does not a lways seal the fistula sufficiently and may compromise the airway caus ing strider and dyspnea. In 30 patients (25 male, 5 female; age 23 to 74 years; mean, 56 years) with very large fistulas and airway problems , me inserted an airway stent (Dynamic) (n=12) or an esophageal tube c ombined with a Dynamic airway stent (n=18) with the aim of sealing the fistula and restoring patency of the airway and GI passage, The trach eobronchial Dynamic stent was chosen because its slightly concave, fle xible posterior silicone membrane adapts ideally to the convex esophag eal tube, The stents were well tolerated and significantly improved th e quality of life. Of 30 patients, 16 could breathe and swallow unimpa ired until shortly before their death. Moderate complaints persisted i n five patients, dysphagia in eight patients, and dyspnea in one patie nt, Mean survival time in the double stent group mas significantly gre ater (110 days) than in the airway stent-only group (24 days) or compa rable groups in the literature treated with esophageal tubes only. We conclude that carefully selected patients can benefit from double sten ting of esophagus and airways.