MALIGNANT ESOPHAGEAL FISTULAS AND PERFORATIONS - MANAGEMENT WITH PLASTIC-COVERED METALLIC ENDOPROSTHESES

PURPOSE: To evaluate prospectively the efficacy of plastic-covered met allic endoprostheses in patients with malignant esophageal fistulas an d perforations. MATERIALS AND METHODS: Thirty-nine patients with incur able esophageal carcinoma who developed esophagorespiratory fistulas ( n = 20) or perforations (n = 19) were treated with plastic-covered met allic stents. RESULTS: Covered Wallstent endoprostheses were placed in 36 patients and covered Gianturco stents in three. All 19 perforation s and 18 of 20 fistulas were successfully closed (clinical success rat e, 95%). Symptoms of aspiration or dysphagia improved in all successfu lly treated patients. Mean survival was 81.8 days (range, 1-370 days). One patient with a closed perforation developed a fistula 16 weeks la ter and was treated with a second, overlapping stent; three patients w ith recurrent fistulas were treated with additional esophageal stents (one patient) or tracheal stents (two patients). In four patients, ste nt migration (two Gianturco and two Wallstent endoprostheses) necessit ated placement of an additional stent. CONCLUSION: Covered metallic st ents offer effective treatment for perforations and fistulas in patien ts with esophageal malignancy. Patients with recurrent fistulas can be treated with additional stents. Fistulas close to the upper esophagea l sphincter may be closed with placement of parallel covered metallic stents in the esophagus and trachea.