Double stenting for esophageal and tracheobronchial stenoses

Background. We examined the complications and outcomes of placing stents fo r both esophageal and tracheobronchial stenoses. Methods. We placed stents for both esophageal and tracheobronchial stenoses in 8 patients (7 with esophageal cancer and 1 with lung cancer). Covered o r noncovered metallic stents were used for the esophageal stenoses, except in 1 patient treated with a silicone stent. Silicone stents were used for t he tracheobronchial stenoses. The grades of esophageal and tracheobronchial stenoses were scored. Results. All patients experienced improvement of grades of both dysphagia a nd respiratory symptoms after stent therapy. The complications were: (1) 2 patients suffered respiratory distress after placement of the esophageal st ent because of compression of the trachea by the stent; and (2) 3 patients developed new esophagotracheobronchial fistulae, and 2 patients had recurri ng fistula symptoms because of growth of preexisting fistulae after the ste nt placement, which were caused by pressure from the 2 stents. Despite the fistulae, the 5 patients treated with covered metallic stents did not compl ain of fistula symptoms, but 2 patients treated with noncovered metallic or silicone stents did complain. Conclusions. For patients with both esophageal and tracheobronchial stenose s, a stent should be introduced into the tracheobronchus first. Because pla cement of stents in both the esophagus and tracheobronchus has a high risk of enlargement of the fistula, a covered metallic stent is preferable for e sophageal cancer involving the tracheobronchus. (Ann Thorac Surg 2000;70:18 03-7) (C) 2000 by The Society of Thoracic Surgeons.