Korean J Radiol.  2010 Apr;11(2):133-140. 10.3348/kjr.2010.11.2.133.

Interventional Management of Esophagorespiratory Fistula

• Shin JH
• Kim JH
• Song HY

• KMID: 1783188
• DOI: http://doi.org/10.3348/kjr.2010.11.2.133

Abstract

An esophagorespiratory fistula (ERF) is an often fatal consequence of esophageal or bronchogenic carcinomas. The preferred treatment is placement of esophageal and/or airway stents. Stent placement must be performed as quickly as possible since patients with ERFs are at a high risk for aspiration pneumonia. In this review, choice of stents and stenting area, fistula reopening and its management, and the long-term outcome in the interventional management of malignant ERFs are considered. Lastly, a review of esophagopulmonary fistulas will also be provided.

Keyword

Interventional technique; Esophagorespiratory fistula; Esophagopleural fistula

MeSH Terms

Bronchial Neoplasms/*complications
Esophageal Fistula/etiology/*therapy
Esophageal Neoplasms/*complications
Esophagus/surgery
Humans
Palliative Care/methods
Quality of Life
Respiratory System/surgery
Respiratory Tract Fistula/etiology/*therapy
*Stents
Treatment Outcome

Figure

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  Fig. 1 Esophagobronchial fistula due to pressure necrosis by esophageal stent. Esophagogram (A) and bronchoscopy (B) after esophageal stent removal shows definite fistula (arrows) at proximal end of stent site. Esophagogram (C) and bronchoscopy (D) after bronchial stent placement (arrows), shows successful closure of fistula.

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  Fig. 2 Esophageal cancer with development of esophagobronchial fistula. Ingested contrast medium is aspirated into left bronchi (A). Right anterior oblique (B) and anteroposterior (C) esophagograms obtained two days after placement of covered expandable metallic stent (18 mm in diameter), shows complete closure of fistula.

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  Fig. 3 Determination of stenting area in various types of esophagorespiratory fistula. A. Esophageal stenting is indicated when esophageal stricture is severe, but with no or only mild airway stricture. B. Airway stenting is indicated when esophageal and airway strictures are non-existent or mild. C. Airway stenting is indicated when airway stricture is severe, but without or with only mild esophageal stricture. D. Both airway and esophageal stenting is indicated when both esophageal and airway stenosis is severe. M and S denotes mild or severe degree of stenosis, respectively.

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  Fig. 4 Esophageal cancer and esophagotracheal fistula. A. Lateral esophagogram shows esophagotracheal fistula (arrow) and segmental luminal narrowing in cervical esophagus. B. Radiograph obtained one week following esophageal stent placement shows diffuse tracheal narrowing (arrows). C. Radiograph obtained following tracheal stent placement to relieve dyspnea. D. Esophagogram obtained one week after tracheal stent placement shows good flow of contrast medium through esophageal stent without visualization of fistula and fully expanded tracheal stent.

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  Fig. 5 Reopening of esophagobronchial fistula caused by food impaction. A. Initial lateral view shows fistula caused by esophageal cancer. Subsequently, placement of covered expandable stent was performed. B. Esophagogram obtained one month after stent placement, shows reopening of fistula (arrow) due to food impaction, which is seen as filling defects within stent. C. This patient underwent passage of inflated balloon catheter (arrow) up and down occluded stent to displace impacted food into stomach. D. Esophagogram obtained after cleansing stent, shows stent patency and disappearance of fistula.

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  Fig. 6 Esophagopulmonary fistula caused by lung cancer. Esophagogram (A) and CT scan (B) show large lung abscess (arrows) connected to esophagus. Immediate (C) and one-month (D) follow-up esophagograms show successful closure of fistula.

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