Mind the gap: A stent between dinner and disaster: A case report on esophageal stenting in the management of tracheoesophageal fistulas

Presentation Notes

Poster presentation at: American College of Physicians, Wisconsin Chapter Annual Scientific Meeting; September 2025; Wisconsin Dells, WI.

Abstract

Introduction: Tracheoesophageal fistula (TEF) is one of the complications seen in patients with esophageal cancer. The incidence of malignant tracheoesophageal fistula has been reported to be around 4.7% to 8.5% in large retrospective studies. Fistulas usually develop as a result of tumor invasion, which causes tissue necrosis and creates an abnormal passage between the trachea and the esophagus. Patients with TEFs typically present with recurrent pneumonia, aspiration, and chronic cough. The self-expanding metallic stent mainly serves as a palliative measure to seal the fistula, relieve symptoms like dysphagia, and improve quality of life. Case description: A 70-year-old male presented with dysphagia initially to solids, which later progressed to include liquids and recurrent episodes of pneumonia unresponsive to prolonged antibiotic therapy. His symptoms gradually worsened over 6 months before he presented to the hospital. Chest CT showed irregular circumferential thickening of the mid-esophagus. Esophagogastroduodenoscopy (EGD) revealed a partially obstructive necrotic mid-esophageal mass and esophageal candidiasis. Biopsy confirmed malignant keratinizing squamous cell carcinoma. A follow-up EGD done 3 months later showed a TEF. The patient was then managed with a selfexpanding esophageal stent to address both the obstructive tumor and the fistula. Post-procedure, the patient was able to drink water with no difficulty and was sent home to gradually advance his diet as tolerated. Discussion: Esophageal stenting is a common treatment of choice for treating malignant TEFs. The American College of Gastroenterology recommends using covered self-expanding metallic stents as the preferred treatment. Studies indicate that initial fistula closure rates range from 70% to 100%, leading to improvements in dysphagia and TEF-related complications such as recurrent pneumonia. In cases with large fistulas and airway compromise, dual esophageal and tracheal stenting has shown benefits. Complications associated with esophageal stents include stent migration, bleeding, airway obstruction, worsening of the fistula, and fistula recurrence.

Type

Poster


 

Share

COinS