Abstract
Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including malignancies, infections, inhalation injuries and traumatic damage. As the condition spans multiple organ systems with varying aetiologies and acuities, TOF poses unique diagnostic and management challenges to pulmonologists, gastroenterologists and thoracic surgeons alike. Although stents have been a cornerstone in the management of TOF, there exists a large gap in our understanding of their efficacy and precise methodology, making stenting procedure both art and science. TOFs relating to underlying oesophageal or tracheal malignancies require advanced understanding of the airway and digestive tract anatomy, dimensions of the fistula, stent characteristics and types, and the interplay between the oesophageal stent and the airway stent if dual stenting procedure is elected. In this review article, we review the most up-to-date data on risk factors, clinical manifestations, diagnostic approaches, management methods and prognosis. Consequently, this article serves to evaluate current therapeutic strategies and the future directions in the areas of 3D-printed stents, over-the-scope clipping systems, tissue matrices and atrial septal closure devices.
Abstract
TOF is a complex, challenging condition with a varying degree of acuity, pathogenesis and therapeutic approaches. As such, there is a need for a comprehensive review of methodologies, stenting techniques and promising novel therapeutic methods. https://bit.ly/2ZYIfaZ
Footnotes
Provenance: Submitted article, peer reviewed
Conflict of interest: H.S. Kim has nothing to disclose.
Conflict of interest: D. Khemasuwan has nothing to disclose
Conflict of interest: J. Diaz-Mendoza has nothing to disclose
Conflict of interest: A.C. Mehta has nothing to disclose
- Received April 17, 2020.
- Accepted May 26, 2020.
- Copyright ©ERS 2020.
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.