Treatment of esophageal fistulas with a new polyurethane-covered, self-expanding mesh stent: a prospective study.

OBJECTIVES

Esophagorespiratory fistulas are serious complications of malignant disease in the esophagus and are associated with rapid deterioration and death. Palliation has thus far consisted of insertion of a plastic stent to occlude the fistula opening. Insertion of these stents is associated with a high complication rate. Our aims were to study the efficacy of a new class of metal stents covered with a membrane with regard to fistula occlusion and lumen patency.

METHODS

Six consecutive patients with esophagorespiratory fistulas were treated with covered expandable metal stents.

RESULTS

In all six patients, no evidence of persisting fistula was seen on contrast radiographs 2 h after stent placement. All patients were able to eat a normal diet after stent insertion and had complete occlusion of their esophagorespiratory fistula. One patient reported pain after the procedure, and the symptoms persisted until death. One patient died of massive hematemesis 5 days after the procedure. Dysphagia scores improved in all patients from a median of 4 to a median of 1, and the Karnofsky score improved from a median of 40% to a median of 65%. Fistulas remained closed until death in all patients.

CONCLUSIONS

Covered expandable metal stents are safe and effective in the palliation of esophagorespiratory fistulas.