Treatment of Esophagopleural Fistulas Using Covered Retrievable Expandable Metallic Stents |
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| Affiliation: | 1. Department of Radiological Science (T.-H.K.), College of Health Science, Kangwon National University, Gangwon Province, South Korea;2. Department of Radiology and Research Institute of Radiology (J.H.S., J.-H.P., J.H.K., H.-Y.S.), University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea;3. Department of Radiology (K.R.K.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;1. Department of Radiology, Division of Vascular and Interventional Radiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908;2. Department of Radiology, Division of Vascular and Interventional Radiology, Brown University, Providence, Rhode Island;3. Department of Physiology, University of Mississippi, Jackson, Mississippi;4. Department of Physiology, University of Louisville, Louisville, Kentucky;5. Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota;6. Vascular & Interventional Specialists of Orange County, Inc., Los Angeles, California;7. Department of Cardiology, Prairie Heart Institute at St. John''s Hospital, Springfield, Illinois;8. Department of Radiology, Division of Vascular and Interventional Radiology, George Washington University, Washington, D.C.;9. Department of Internal Medicine, Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia;10. Department of Internal Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, California;11. Department of Radiology, Division of Vascular and Interventional Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas;1. Department of Imaging, Division of Vascular Imaging and Intervention, Massachusetts General Hospital, 290 Gray/Bigelow, 55 Fruit Street, Boston, MA 02114;2. Department of Pathology and Center for Systems Biology, Massachusetts General Hospital, 290 Gray/Bigelow, 55 Fruit Street, Boston, MA 02114;3. Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, 290 Gray/Bigelow, 55 Fruit Street, Boston, MA 02114;4. Harvard Medical School, Boston, Massachusetts;1. Vascular Disease Research Center, Rhode Island Hospital, Gerry 337, 593 Eddy Street, Providence, RI 02903;2. Division of Nephrology, Rhode Island Hospital, Gerry 337, 593 Eddy Street, Providence, RI 02903;3. Division of Cardiology, University of Toledo, Toledo, Ohio;4. Division of Cardiology, Beth Israel Deaconess Hospital, Boston;5. Harvard Clinical Research Institute, Boston;6. Division of Cardiology, Massachusetts General Hospital, Boston;7. Department of Biostatistics, Boston University, Boston, Massachusetts;8. Department of Radiology, University of Virginia, Charlottesville, Virginia;9. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan;10. Interventional Institute, Holy Name Medical Center, Teaneck, New Jersey;11. University of Texas Health Sciences at San Antonio, San Antonio, Texas;12. Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia;13. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland;1. Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA;2. Department of Pathology, Florida Hospital, Orlando, Florida, USA;3. Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA;4. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA;1. Department of Radiology (K.A.G.), Namik Kemal University School of Medicine, Tekirdag;2. Department of Radiology (C.E., B.H.), Uludag University School of Medicine, Bursa, Turkey |
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| Abstract: | PurposeTo evaluate the clinical efficacy of placement of covered retrievable expandable metallic stents for esophagopleural fistulas (EPFs).Materials and MethodsDuring the period 1997–2013, nine patients with EPF were treated using covered retrievable expandable metallic stents. The underlying causes of EPF were esophageal carcinoma (n = 6), lung cancer (n = 2), and postoperative empyema for Boerhaave syndrome (n = 1).ResultsTechnical success was achieved in eight patients (88.9%). In one patient, incomplete EPF closure was due to incomplete stent expansion. Clinical success, defined as complete EPF closure within 7 days, was achieved in five patients (55.6%). Overall fistula persistence (n = 1) or reopening (n = 4) occurred in five patients (55.6%) 0–15 days after stent placement. The causes of reopening were due to the gap between the stent and the esophagus (n = 3) or stent migration (n = 1). For fistula persistence or reopening, additional interventional management, such as gastrostomy, stent removal, or stent reinsertion, was performed. Stent migration occurred as a complication in one patient with EPF from a benign cause secondary to postoperative empyema. In the eight patients who died during the follow-up period, the mean and median survival times were 78.8 days and 46 days, respectively.ConclusionsPlacement of a covered expandable metallic esophageal stent for the palliative treatment of EPF is technically feasible, although the rate of clinical success was poor secondary to fistula persistence or reopening. Fistula reopening was caused by the gap between the stent and the esophagus or by stent migration, and additional interventional treatment was useful to ensure enteral nutritional support. |
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| Keywords: | EPF" },{" #name" :" keyword" ," $" :{" id" :" key0010" }," $$" :[{" #name" :" text" ," _" :" esophagopleural fistula PTFE" },{" #name" :" keyword" ," $" :{" id" :" key0020" }," $$" :[{" #name" :" text" ," _" :" polytetrafluoroethylene |
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