Clin Endosc.  2023 Nov;56(6):761-768. 10.5946/ce.2022.297.

Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer

• Josino IR
• Martins BC
• Machado AA
• de A. Lima GR
• Cordero MAC
• Pombo AAM
• Sallum RAA
• Ribeiro Jr U
• Baron TH
• Maluf-Filho F

• KMID: 2547898
• DOI: http://doi.org/10.5946/ce.2022.297

Abstract

Background/Aims
Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer.
Methods
This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study.
Results
Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival.
Conclusions
The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

Keyword

Esophageal cancer; Esophageal fistula; Self-expandable metallic stents

Figure

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  Fig. 1. Bronchoscopy showing the proximal flare of an esophageal Self-expandable metal stent partially inside the tracheal lumen.

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  Fig. 2. Flowchart of patients included in the study. SEMS, self-expandable metallic stent; SEMS-ERF, SEMS-induced esophagorespiratory fistula.

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  Fig. 3. Kaplan-Meier overall survival curve. (A) All patients included. (B) Only patients with squamous cell carcinoma.

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