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Published online before print May 27, 2004, 10.1148/radiol.2321030733
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(Radiology 2004;232:252-259.)
© RSNA, 2004

Vascular and Interventional Radiology

Esophagorespiratory Fistula: Long-term Results of Palliative Treatment with Covered Expandable Metallic Stents in 61 Patients1

Ji Hoon Shin, MD, Ho-Young Song, MD, Gi-Young Ko, MD, Jin-Oh Lim, BS, Hyun-Ki Yoon, MD and Kyu-Bo Sung, MD

1 From the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, Korea. From the 2002 RSNA scientific assembly. Received May 9, 2003; revision requested July 21; final revision received November 25; accepted December 10. Supported by grant HMP-98-G-2–043 for a Highly Advanced National Project, Ministry of Health and Welfare, Republic of Korea. Address correspondence to H.Y.S. (e-mail: hysong@amc.seoul.kr).

PURPOSE: To evaluate long-term clinical results of palliative treatment of esophagorespiratory fistulas (ERFs) with covered expandable metallic stents.

MATERIALS AND METHODS: Sixty patients with ERFs due to esophageal or bronchogenic carcinoma and one patient with ERF due to pressure necrosis caused by initial esophageal stent placement for esophageal carcinoma were treated with covered expandable esophageal or tracheobronchial metallic stents. Information about technical success of stent placement, initial clinical success and failure, fistula reopening, and complications was obtained. Survival curves for both patient groups with initial clinical success and failure were obtained and compared with Kaplan-Meier methods and log-rank test.

RESULTS: Stent placement was technically successful in all patients, with no immediate procedural complications. The stent completely sealed off the fistula in 49 (80%) of 61 patients so that they had no further aspiration symptoms (initial clinical success). Twelve (20%) of 61 patients had persistent aspiration symptoms due to incomplete ERF closure (initial clinical failure). During follow-up, the fistula reopened in 17 (35%) of 49 patients with initial clinical success: In eight patients, the reopened ERF was sealed off successfully with stent placement or balloon dilation. In two patients with reopened ERF caused by food impaction, the reopened fistula resolved spontaneously. Seven patients did not undergo further treatment. All patients died during follow-up, and mean survival was 13.4 weeks (range, 1–56 weeks) after stent placement. Mean survival in patients with initial clinical success was significantly longer than that in patients with initial clinical failure (15.1 vs 6.2 weeks, P < .05).

CONCLUSION: Covered expandable metallic stents were placed in 61 patients with ERFs, but the initial clinical success rate was poor and the rate of reopening was high; however, interventional treatment was effective for sealing off reopened ERFs.

© RSNA, 2004

Index terms: Esophagus, grafts and prostheses, 71.1269 • Esophagus, interventional procedures, 71.1269 • Esophagus, stenosis or obstruction, 71.1432 • Fistula, gastrointestinal tract, 71.245 • Fistula, pulmonary, 60.24




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