Malignant aerodigestive fistulae are rare but devasting sequelae of thoracic cancers. Most commonly associated with esophageal cancer, survival following fistula development is measured in weeks. Palliation is the primary goal of therapy and to this end, we report the use of self-expanding metallic stents (SEMS) as treatment of these fistulae.
Between May 1999 and January 2004, 12 patients were treated for malignant aerodigestive fistulae. The underlying diagnosis was esophageal cancer for 10 patients and non-small cell lung cancer in two others. All patients were symptomatic and fistulae were diagnosed by esophagoscopy in 7, bronchoscopy in 2, and esophagram in 3. Seven covered WallstentsTM (6 esophageal and 1 tracheal) and 8 covered UltraflexTM (5 tracheal and 3 esophageal) were used.
A single stent was placed in 8 patients (6 esophageal and 2 tracheal). Three patients required esophageal and tracheal stents and one patient needed 2 tracheal stents. General anesthesia was required for 6 patients. There were no procedure-related complications. Symptoms were palliated in 100% (12/12) of patients and oral intake was reinstituted in 42% (5/12). All patients were discharged from hospital after SEMS placement and 1 patient returned for uneventful tracheal stent replacement secondary to mucus impaction 2 months later.
SEMS placement is an effective strategy to palliate malignant aerodigestive fistulae. Complications are rare and symptoms are alleviated in most patients.
SEMS have simplified the management of malignant aerodigestive fistulae.
G.V. Gonzalez-Stawinski, None.