Endoscopic Treatment with a Cuffed Prosthesis for Esophago - tracheal Fistula without Esophageal Stricture in a Patient with Malignant Lymphoma

Lee, Sang In; Kim, Young Soo; Cho, Sung Won; Hahm, Ki Baik; Kim, Jin Hong; Park, Young Sook; Hong, Sa Joon; Lee, Kwang Jae

Abstract

An esophago-tracheal fistula is a distressing and rapidly fatal complication of cancer infiltrating the mediastinum. The passage of swallowed saliva and solid or liquid food into the bronchial tree causes coughing and frequent episodes of putmonary infection and collapse. Curative resection is generally impossible due to the extent of the malignant leision and respiratory disability. In principle, peroral endoscopic intubatian provides the best available palliative therapy. Peroral intubation with a standard prosthesis fails to occlude inoperable malignant esopbago-tracheal fistulas located above the narrowed segment or when there is little or no stricture at all. To overcome these problems, the fistula is iniubated perorally with a prosthesis surrounded by a foam rubber cuff contained in silicone sheath, in which a vacuum can be created. The cuffed esophageal prosthesis can improve the quality of life in patients with malignant esophago-tracheal fistulas that do not respond to conventional intubation. We experieneed a case of the endoscopic treatment with a cuffed prosthesis for esophago-tracheal fistula without esophageal stricture in a patient with malignant lymphoma. After treatment, there were no symptoms related to the fistula and good transit of food was achieved. So we report this case with a brief review of the previous literatures.