Palliative Esophageal Stenting for Esophagorespiratory Fistula in Patients with Esophageal Cancer
Abstract
Objective: This study aimed to evaluate the clinical outcomes following the placement of self-expandable metal stents (SEMS) in patients with esophagorespiratory fistula (ERF), due to esophageal squamous cell carcinoma (ESCC).
Material and Methods: Forty-three patients with ERF in ESCC underwent esophageal SEMS placement at Songklanagarind Hospital, Thailand, from January 2008 to June 2023. Data on initial clinical success and failure, complications, stent patency, and survival were collected.
Results: Technical success was achieved in all patients, with an initial clinical success rate of 28 of 43 (65.1%) and initial clinical failure occurring in 15 of 43 (34.9%). Among the 28 patients with initial clinical success, 13 developed recurrent symptoms: aspiration symptoms recurred in 61.5% (8 of 13) and dysphagia symptoms recurred in 38.5% (5 of 13). Persistent aspiration pneumonia, 53.3% (8 of 15), and persistent dysphagia symptoms, 46.7% (7 of 15), occurred in the 15 patients who had initial clinical failure. The overall major complication rate was 34.9% (15 of 43). The median stent patency duration was 38.5 days (interquartile range (IQR), 25.8-112.2) and the median survival duration was 40 days (IQR, 14-89.5). Survival was significantly lower in cases of initial clinical failure (14 days, IQR 6.5–32 days) compared to initial clinical success (72 days, IQR 27-197.2 days) (p-value<0.001).
Conclusion: Palliative esophageal SEMS placement for ERF in patients with ESCC is technically easy, effective, safe, and provides short-term relief of aspiration, including dysphagia. Initial clinical success led to longer survival than initial clinical failure.
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