TREATMENT OF ESOPHAGORESPIRATORY FISTULAS WITH SILICONE-COATED SELF-EXPANDING METAL STENTS

Nine self-expanding silicone-coated modified Gianturco metal stents we re inserted in 8 patients (mean age, 58.2 years) for palliation of mal ignant esophagorespiratory fistulas caused by esophageal (n = 5) or br onchial (n = 3) carcinoma. One patient with a fistula above a 12-cm-lo ng malignant stenosis received two overlapping stents. The implantatio n procedure was well tolerated by all patients under intravenous sedat ion and analgesia. After release, the stents expanded to their full di ameter, leading to complete occlusion of the fistulas and bridging of the concomitant stenoses. Two patients with lung cancer received an ad ditional tracheobronchial stent before esophageal stent insertion. Fai lure to maintain complete contact between the proximal stent margin an d the esophageal wall led to insufficient sealing of the fistula of 1 patient and recurrent aspiration, manifested 6 days after stent implan tation (overall success, 87.5%). The other patients could swallow semi solid food until death. Seven patients died of advanced metastatic dis ease after 21 to 121 days (mean, 54 days) and 1 patient of massive hem optysis 10 days after stent placement, which could be regarded as a co mplication (procedure-related mortality rate, 12.5%). These preliminar y results suggest that peroral insertion of the modified silicone-coat ed Gianturco stent is a rapid, reasonably safe, and effective procedur e for palliation of malignant esophagorespiratory fistulas.