Zori A G, Jantz M A, Forsmark C E, Wagh M S
Division of Gastroenterology, University of Florida, Gainesville, Florida, USA.
Dis Esophagus. 2014 Jul;27(5):428-34. doi: 10.1111/dote.12120. Epub 2013 Aug 13.
Management of esophago-airway fistulas (EAF) and obstructions often involves therapy with esophageal and/or airway stents. We present a unique approach for the management of EAF and obstructions with simultaneous upper endoscopy and bronchoscopy (two scopes inserted simultaneously through the mouth). The aim is to assess the efficacy and safety of a simultaneous dual scope approach for management of EAF and obstructions. The endoscopy database at the University of Florida was reviewed from October 2007 to April 2012 to identify adult patients who had undergone simultaneous upper endoscopy and bronchoscopy for EAF and obstructions. Medical records were reviewed for demographics, indication, pathology, imaging, simultaneous endoscopic and bronchoscopic findings/maneuvers, outcomes, and adverse events. Outcomes assessed included: (i) technical success, (ii) fistula occlusion, (iii) dysphagia score, and (iv) adverse events. Thirteen patients with EAF and/or obstruction underwent simultaneous dual scope endoscopy. Dual scope procedures were technically successful in 12/13 (92%) patients. Dysphagia score improved from three to one in both patients with dysphagia without EAF. Fistula occlusion was observed in 7/10 patients (70%) with EAF. With this technique, stents were placed accurately without airway compression, migrated esophageal stents extracted from the tracheal lumen without trauma, and tracheal stents not displaced during esophageal manipulations. EAF not otherwise apparent were identified in two patients. Adverse events occurred in 2/13 (15%) patients, and 5/13 (38%) patients died from advanced cancer during follow up (mean 4.1 months, range 1-8 months). Simultaneous dual scope (two scopes inserted through the mouth at the same time) therapy of EAF and obstructions is feasible, effective, and safe, and may develop to be the preferred approach for the management of complex esophago-airway diseases.
食管气道瘘（EAF）和梗阻的治疗通常涉及食管和/或气道支架治疗。我们介绍一种独特的方法，即通过同时进行上消化道内镜检查和支气管镜检查（两根内镜经口同时插入）来治疗EAF和梗阻。目的是评估同时使用双镜检查法治疗EAF和梗阻的有效性和安全性。回顾了佛罗里达大学2007年10月至2012年4月的内镜数据库，以确定因EAF和梗阻接受过上消化道内镜检查和支气管镜检查的成年患者。查阅病历以了解人口统计学资料、适应证、病理学、影像学、同时进行的内镜和支气管镜检查结果/操作、结局及不良事件。评估的结局包括：（i）技术成功，（ii）瘘口闭塞，（iii）吞咽困难评分，以及（iv）不良事件。13例EAF和/或梗阻患者接受了同时双镜检查。双镜操作在12/13（92%）的患者中技术成功。无EAF的吞咽困难患者的吞咽困难评分从3分改善至1分。10例EAF患者中有7例（70%）观察到瘘口闭塞。使用该技术，支架放置准确，无气道受压，从气管腔内取出移位的食管支架时无创伤，且在食管操作过程中气管支架未移位。两名患者发现了未被其他方法发现的EAF。2/13（15%）的患者发生不良事件，5/13（38%）的患者在随访期间（平均4.1个月，范围1 -
8个月）死于晚期癌症。同时双镜检查法（两根内镜经口同时插入）治疗EAF和梗阻是可行、有效且安全的，可能会成为治疗复杂食管气道疾病的首选方法。
