Treatment of esophagopleural fistulas using covered retrievable expandable metallic stents

Tae Hyung Kim, Ji Hoon Shin, Kyung Rae Kim, Jung Hoon Park, Jin Hyoung Kim, Ho Young Song

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Purpose To evaluate the clinical efficacy of placement of covered retrievable expandable metallic stents for esophagopleural fistulas (EPFs). Materials and Methods During the period 1997-2013, nine patients with EPF were treated using covered retrievable expandable metallic stents. The underlying causes of EPF were esophageal carcinoma (n = 6), lung cancer (n = 2), and postoperative empyema for Boerhaave syndrome (n = 1). Results Technical success was achieved in eight patients (88.9%). In one patient, incomplete EPF closure was due to incomplete stent expansion. Clinical success, defined as complete EPF closure within 7 days, was achieved in five patients (55.6%). Overall fistula persistence (n = 1) or reopening (n = 4) occurred in five patients (55.6%) 0-15 days after stent placement. The causes of reopening were due to the gap between the stent and the esophagus (n = 3) or stent migration (n = 1). For fistula persistence or reopening, additional interventional management, such as gastrostomy, stent removal, or stent reinsertion, was performed. Stent migration occurred as a complication in one patient with EPF from a benign cause secondary to postoperative empyema. In the eight patients who died during the follow-up period, the mean and median survival times were 78.8 days and 46 days, respectively. Conclusions Placement of a covered expandable metallic esophageal stent for the palliative treatment of EPF is technically feasible, although the rate of clinical success was poor secondary to fistula persistence or reopening. Fistula reopening was caused by the gap between the stent and the esophagus or by stent migration, and additional interventional treatment was useful to ensure enteral nutritional support.

Original languageEnglish (US)
Pages (from-to)623-629
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume25
Issue number4
DOIs
StatePublished - Apr 2014
Externally publishedYes

Keywords

  • Abbreviations
  • EPF
  • esophagopleural fistula
  • polytetrafluoroethylene
  • PTFE

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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