Elsevier

The Annals of Thoracic Surgery

Volume 70, Issue 6, December 2000, Pages 1803-1807
The Annals of Thoracic Surgery

Original article: general thoracic
Double stenting for esophageal and tracheobronchial stenoses

https://doi.org/10.1016/S0003-4975(00)02042-7Get rights and content

Abstract

Background. We examined the complications and outcomes of placing stents for both esophageal and tracheobronchial stenoses.

Methods. We placed stents for both esophageal and tracheobronchial stenoses in 8 patients (7 with esophageal cancer and 1 with lung cancer). Covered or noncovered metallic stents were used for the esophageal stenoses, except in 1 patient treated with a silicone stent. Silicone stents were used for the tracheobronchial stenoses. The grades of esophageal and tracheobronchial stenoses were scored.

Results. All patients experienced improvement of grades of both dysphagia and respiratory symptoms after stent therapy. The complications were: (1) 2 patients suffered respiratory distress after placement of the esophageal stent because of compression of the trachea by the stent; and (2) 3 patients developed new esophagotracheobronchial fistulae, and 2 patients had recurring fistula symptoms because of growth of preexisting fistulae after the stent placement, which were caused by pressure from the 2 stents. Despite the fistulae, the 5 patients treated with covered metallic stents did not complain of fistula symptoms, but 2 patients treated with noncovered metallic or silicone stents did complain.

Conclusions. For patients with both esophageal and tracheobronchial stenoses, a stent should be introduced into the tracheobronchus first. Because placement of stents in both the esophagus and tracheobronchus has a high risk of enlargement of the fistula, a covered metallic stent is preferable for esophageal cancer involving the tracheobronchus.

Section snippets

Material and methods

From 1991 to 1999, we performed stent therapy for 28 patients with esophageal stenoses and 45 patients with tracheobronchial stenoses. Of these, 8 patients received stent therapy for both esophageal and tracheobronchial stenoses (Table 1). The causes of the stenoses were esophageal cancer in 7 patients and lung cancer in 1. The mean length of esophageal stenoses in the esophageal cancer patients was 5.7 cm (range: 3–9). The sites of airway stenoses were the trachea in 5 patients, the left main

Results

Immediate improvement of grades of both respiratory symptoms and dysphagia was achieved in all patients after stent placements (Table 2). The symptoms of tracheobronchial stenoses did not recur in any of our cases until the patients’ death. The symptoms of esophagotracheobronchial fistulae also improved after the placement of esophageal covered metallic stent. The mean period of taking meals without the nutritional support after esophageal stent placements was 5 months (range, from 2–16

Comment

Although our study showed that double stenting for esophageal and tracheobronchial stenoses effectively relieved symptoms, we discovered 2 main complications: (1) in patients with both esophageal and tracheal stenoses, the tracheal stenoses can deteriorate if they are compressed by the esophageal stents; and (2) with double stents, there is a high risk of fistula occurring or growing because of necrosis of both the esophageal and tracheobronchial walls from the pressure of the stents.

Two of our

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