Scientists from the Asan Medical Center at the University of Ulsan College of Medicine in Seoul, Korea, evaluated the long-term clinical results from 61 patients with esophagorespiratory fistulas (ERFs) who received palliative treatment with covered expandable metallic stents.
All the patients had ERFs due to esophageal or bronchogenic carcinoma, apart from one, who had ERF due to pressure necrosis caused by initial esophageal stent placement for esophageal carcinoma.
|Intervention treatment was effective for sealing off reopened ERFs|
Each patient was treated with either covered expandable or tracheobronchial metallic stents.
The researchers then collected information about the technical success of stent placement, initial clinical success and failure, and fistula reopening. Information about complications was also recorded.
Survival curves for both patient groups with initial clinical success and failure were obtained and compare with Kaplan-Meier methods and log-rank test.
Led by Dr Ji Hoon Shin, the research team conducting the study recorded technically successful stent placement in all patients, with no immediate procedural complications.
In 49 (80%) of the 61 study patients the stent completely sealed off the fistula, so that they had no further aspiration symptoms. These patients were classed as having 'initial clinical success'.
The remaining 12 patients (20%) had persistent aspiration symptoms due to incomplete ERF closure, and were classed as having 'initial clinical failure'.
During follow-up the fistula reopened in 17 (35%) of the 49 patients with initial clinical success. In 8 of these patients, the reopened ERF was successfully sealed off with stent placement or balloon dilation.
In two cases where the fistula had reopened, this was due to food impaction and the reopened fistula resolved spontaneously.
Seven people required no further treatment.
All patients died during follow-up, with mean survival being 13.4 weeks (range 1 to 56 weeks) after stent placement.
However, mean survival was significantly longer in patients with initial clinical success than in those with initial clinical failure (15.1 vs. 6.2 weeks).
The researchers conclude that although initial clinical success rate following the placement of the covered expandable metallic stents was poor in the ERF patients, and reopening was also high, interventional treatment was nonetheless effective for sealing off reopened ERFs.