Palliation of malignant tracheo-oesophageal fistula using covered metal stents.

Nine patients presenting with malignant tracheo-oesophageal fistula have been treated by placing covered oesophageal stents (seven Wallstent, two Gianturco) within the oesophageal lumen over a twelve month period. Five patients had oesophageal carcinoma, two bronchial carcinoma, one metastatic renal cell carcinoma, one developed malignant change within a longstanding tuberculous tracheo-oesophageal fistula. Initial closure of the fistula was successful in six cases. Three failed due to technical problems (one with a Wallstent and both cases with the Gianturco stents). There were no immediate complications and normal diet resumed within 24 h in the six successful cases. One patient was aware of the physical presence of the stent (for a high fistula), the remainder of the stents were well tolerated. Covered metal stents offer a minimally invasive, effective form of palliation in certain patients with malignant tracheo-oesophageal fistulae. Accurate positioning using fluoroscopic guidance is essential in gaining optimal stent position.