Successful endoscopical sealing of malignant esophageotracheal fistulae byusing a covered self-expandable stenting system

Objective:Any treatment of tracheo-esophageal fistulae in end-stage maligna nt stenosis of the esophagus must be weighed against associated morbidity a nd mortality. In a prospective study we investigated benefits and risks of the use of one type of coated. self-expandable stent. Patients and methods: We treated four male and two female patients. (mean age 68.3 years. range: 38-90 years), with malignant esophago-tracheal fistula non-resectable due to advanced tumour stage and/or functional reasons. All were in a poor gene ral condition suffering from aspiration pneumonia and malnutrition. Four ou t of the six patients had had one or multiple extra- or endoluminal palliat ive treatments at a mean interval of 191 days (range: 7 days-15 ms) since t he last intervention. The fistulae were sealed by using a covered, self-exp andable stent (ULTRAFLEX esophageal stent system, Microinvasive, Boston Sci entific Corporation, Boston, MA). Results: Stenting did not cause any techn ical problems and all fistulae were successfully sealed in a one-step proce dure. The median hospital stay was 4.6 days (range: 3-9 days). Except for o ne late stent induced recurrent fistula treated by re-stenting and tracheos tomy. we did not observe any stent associated complications. Five patients died of tumour generalization. The median survival of the patients who died was 78 days (range: 35-129 days). One patient is alive and well at 120 day s after stenting. Conclusion: In spite of the small number of patients the results suggest that this type of stent represents a safe and efficient app roach for palliative endoscopic treatment of this high risk group. Local pr etreatment does not preclude the successful use of the self-expandable coat ed stent. (C) 2001 Elsevier Science B.V. All rights reserved.