Esophageal stents are increasingly being placed for palliation of malignant dysphagia. The present study was conducted to look at the pulmonary complications of esophageal stent necessitating fiberoptic bronchoscopy and to identify risk factors predicting the need for fiberoptic bronchoscopy.
We identified all patients who had an esophageal stent placed at Mayo Clinic between 1998 and 2002, and those who subsequently underwent Fiberoptic Bronchoscopy. Bronchoscopic findings and intervention required were noted. The Fischer exact test was applied to see if there were any factors which significantly increased the risk of a patient getting a fibreoptic bronchoscopy.
A total of 103 patients’had an esophageal stent placed. Eighty-four (81%) patients had esophageal cancer. A total of 46(44%) had esophageal dilatation / laser therapy prior to esophageal stent placement. Tracheo-esophageal fistula was present prior to stent placement in 5(4.8%) patients. Treatment records were available for 68 patients of which 57(83%) received radiotherapy or chemotherapy. A total of 7 (6.7%) patients with esophageal stent required fibreoptic bronchoscopy. Dyspnea and cough were the main reason for bronchoscopy. Esophageal stent perforating into the trachea was seen in 4(3.8%) patients, 2(1.9%) required placement of airway stent. External airway compression was seen in 1 patient. Factors influencing the requirement of fibreoptic bronchoscopy in patients with esophageal stent were analyzed. Presence of tracheoesophageal fistula was a significant factor p = 0.001. Diagnosis, previous esophageal dilatations/laser therapy, treatment with either radiotherapy / chemotherapy, were not significantly associated with the need for fibreoptic bronchoscopy.
In the present study a total of 7 patients (6.7%) with esophageal stent required fibreoptic bronchoscopy. The esophageal stent was seen perforating into the trachea in 4(3.8%) patients, of these 2(1.9%) had airway stent placed. External airway compression was seen in 1 patient.The presence of tracheoesophageal fistula at the time of esophageal stent placement predicted the need for fiberoptic bronchoscopy.
Patients with tracheoesophageal fistulas treated with esophageal stent will likely develop airway compromise requiring airway intervention.
S. Rana, None.