Individualized airway-covered stent implantation therapy for thoracogastric airway fistula after esophagectomy.

Background: Thoracogastric airway fistula (TGAF) is a rare and dangerous complication of esophagectomy performed for esophageal and cardiac carcinomas. Herein, we aimed to explore the feasibility and efficacy of individualized airway stent implantation for the treatment of TGAF after esophagectomy. Methods: Based on different TGAF types and relevant data on chest computed tomography, customized airway-covered stents were positioned so as to cover the entrance to the fistula by an interventional radiologist using fluoroscopic guidance. Results: Of the 63 patients with TGAF, 12 had thoracogastric-tracheal fistulas, 14 had thoracogastric-carinal fistulas, 21 had thoracogastric-left main bronchial fistulas, 15 had thoracogastric-right main bronchial fistulas, and 1 had a thoracogastric-right intermediate bronchial fistula. The following different stent types were placed: 7 straight self-expandable covered metallic stents, 2 hinged self-expandable covered metallic stents, 41 Y-shaped self-expandable covered metallic stents, and 13 large Y and small Y paired self-expandable covered metallic stents. In all 59 cases (93.65 %), the implantation was successful at the first attempt, with the procedure times ranging from 5 to 10 min. Esophagograms with water-soluble iodinated contrast showed that the fistulae were completely covered with no contrast flowing into the airways and lungs, and with the stents fully expanded. We recorded four cases (6.35 %) of incomplete or recurrent fistula closure. Conclusion: Customized airway-covered stents may be an appropriate palliative therapy for patients with thoracogastric airway fistula who are unfit for surgery or have a high postoperative risk. [ABSTRACT FROM AUTHOR]

Copyright of Surgical Endoscopy & Other Interventional Techniques is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)