Malignant tracheoesophageal fistula (MTEF) is a serious complication of cancer arising in the esophagus, lung or tracheobronquial tree. Approximately 77% of MTEF are related to esophageal cancer while around 16% are originated from a primary lung neoplasm. Treatment is usually palliative and involves restoration of the swallowing mechanism and prevention of aspiration. Prosthesis placement is considered to be appropriate for most patients with MTEF, a variety of them are available.
We have designed a new cufflink-shaped soft silicon prosthesis, directed to occlude the aero digestive connection. (Picture 1) The DJ® silicon prosthesis, (Barcelona, Spain) can be safely placed under direct vision using a rigid bronchoscope and a biopsy forceps. The new stent is available in different sizes, in order to be able to select the appropriate one according to the patient we are treating. Some patients may require costume-made prosthesis.
Under general anesthesia and after tracheal intubation with the rigid bronchoscope, the place and size of the lesion is assessed and the stent selected. The device is then folded with a biopsy forceps, flattening both wings. Under direct vision, the flattened stent is introduced through the fistula orifice with a soft rotation and pushing motion, until one of the wings is thought to be into the esophageal lumen. Then the stent is allowed to deploy, obtaining complete and immediate occlusion of the fistula. (Picture 2).
We are presenting this preliminary report because we believe the new prosthesis design offers advantages over the stents generally used for palliation of MTEF. It is a soft, easy to place silicon prosthesis that is sized exactly to the fistula diameter, offering a very small contact area, which can avoid potential complications such as increase fistula size, wall erosion, perforation and bleeding.
More experience is needed in order to recommend its generalized use, but the DJ® prosthesis appears as a good supportive care option in selected patients with MTEF.
Pablo Diaz-Jimenez, Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Dr Diaz-Jimenez has designed the DJ (R) Prosthesis, which is not in the market at the moment