Long-Term Control of Recurrent Tracheoesophageal Fistulas and Stenoses by Multiple Stenting

A Case Report

Abstract

A 57-year-old man with tracheoesophageal fistulas and stenoses resulting from esophageal cancer was treated with multiple stenting. The patient had already received total laryngectomy for laryngeal cancer and radiation therapy for midpharyngeal cancer and oral cancer. The first fistula was sealed by a covered self-expanding esophageal stent; however, airway stenosis resulting from compression by the stent developed 1.5 months after stenting. A self-expanding metallic stent was introduced into the trachea, and airway stenosis improved. After an additional 3.5 months, the patient experienced aspiration pneumonia because of a new tracheoesophageal fistula arising below the inferior border of the first esophageal stent. A new, covered self-expanding stent was again placed into the esophagus to occlude the new fistula. Two months later, the respiratory tract between the cutaneous stoma after laryngectomy and the upper trachea became narrow as a result of disease progression. The fourth self-expanding metallic stent was placed at the entry of the respiratory tract to counteract the stenosis. With each stenting, the complaints of the patient were relieved quickly and his quality of life recovered. He lived for 304 days after insertion of the first stent, and he died of aspiration pneumonia caused by the third esophagorespiratory fistula.

Journal of Bronchology7:244-247, 2000.