Fabien Maldonado
Last active: 2/1/2016

Stent-associated esophagorespiratory fistulas: incidence and risk factors.

Bick BL, Song LM, Buttar NS, Baron TH, Nichols FC, Maldonado F, Katzka DA, Enders FT, Topazian MD
Gastrointest Endosc. 2013 77 (2): 181-9

PMID: 23245798 · DOI:10.1016/j.gie.2012.10.004

BACKGROUND - Esophageal self-expandable stents (SESs) effectively treat strictures and leaks but may be complicated by a stent-associated esophagorespiratory fistula (SERF). Little is known about SERFs.

OBJECTIVE - To determine the incidence, morbidity, mortality, and risk factors for SERF.

DESIGN - Retrospective case-control study.

SETTING - Single referral center.

PATIENTS - All adults undergoing esophageal SES placement during a 10-year period.

INTERVENTION - Stent placement.

MAIN OUTCOME MEASUREMENTS - Occurrence of SERF, morbidity, and mortality.

RESULTS - A total of 16 of 397 (4.0%) patients developed SERF at a median of 5 months after stent placement (range 0.4-53 months) including 6 of 94 (6%), 10 of 71 (14%), and 0 of 232 (0%) of those with lesions in the proximal, middle, and distal esophagus, respectively (overall P < .001). SERF occurred in 10% of those with proximal and mid-esophageal lesions, including 14% with benign strictures, 9% with malignant strictures, and none with other indications for SES placement (P = .27). The risk was highest (18%) in patients with benign anastomotic strictures. Risk factors for development of SERF included a higher Charlson comorbidity index score (odds ratio [OR] 1.47 for every 1-point increase; P = .04) and history of radiation therapy (OR 9.41; P = .03). Morbidity associated with SERF included need for lifelong feeding tubes in 11 of 22 (50%) and/or tracheostomy or mechanical ventilation in 5 of 22 (23%). Median survival after diagnosis was 4.5 months (range 0.35-67), and 7 patients survived less than 30 days.

LIMITATIONS - Retrospective design, limited statistical power.

CONCLUSION - SERF is a morbid complication of SES placement for strictures of the proximal and mid-esophagus. The dominant risk factors for development of SERF are prior radiation therapy and comorbidity score.

Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

MeSH Terms (20)

Adult Aged Aged, 80 and over Bronchoscopy Case-Control Studies Esophageal Stenosis Esophagoscopy Female Follow-Up Studies Humans Incidence Kaplan-Meier Estimate Logistic Models Male Middle Aged Retrospective Studies Risk Factors Stents Tracheoesophageal Fistula Treatment Outcome

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