The management of malignant esophago-respiratory fistulas with a cuffed prosthesis

Endoscopy. 1990 Nov;22(6):241-4. doi: 10.1055/s-2007-1012861.

Abstract

Peroral intubation with a standard prosthesis fails to occlude inoperable malignant esophago-respiratory fistulas located above the narrowed segment, or when there is little or no stricture at all. Ten patients with malignant esophago-respiratory fistulas were intubated perorally with a prosthesis surrounded by a foam ruber cuff contained in a silicone sheath, in which a vacuum can be created. The type of fistula was esophago-bronchial in 6 patients, esophago-tracheal in 3 patients, and gastro-tracheal in 1 patient. The fistula was located above the stricture in 8 patients and in a malignancy without a stricture in 2 patients. The diameter of the opening of the fistula ranged between 1 and 3 cm. Complications with the cuffed tube were recurrent leakage after a period of 30 days in situ in 1 patient, and compression of the trachea immediately after intubation in 1 patient. Adequate palliation, that is, no symptoms related to the fistula, good transit of food and discharge from hospital within a few days was achieved in 9 patients for an average period of 37.2 days (10-84 days). The cuffed esophageal prosthesis can improve the quality of life in patients with malignant esophago-respiratory fistulas that do not respond to conventional intubation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bronchial Fistula / therapy*
  • Esophageal Fistula / therapy*
  • Female
  • Gastric Fistula / therapy
  • Humans
  • Intubation, Intratracheal / instrumentation*
  • Male
  • Middle Aged
  • Palliative Care / instrumentation
  • Prostheses and Implants*
  • Prosthesis Design
  • Tracheal Diseases / therapy
  • Tracheoesophageal Fistula / therapy*