HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Donald E. Low Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Low, D. E. Articles by Kozarek, R. A. Search for Related Content PubMed PubMed Citation Articles by Low, D. E. Articles by Kozarek, R. A.

Ann Thorac Surg 1998;65:919-923
© 1998 The Society of Thoracic Surgeons

Comparison of Conventional and Wire Mesh Expandable Prostheses and Surgical Bypass in Patients With Malignant Esophagorespiratory Fistulas

^a Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA
^b Section of Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington, USA

Accepted for publication October 27, 1997.

Address reprint requests to Dr Low, Department of General Surgery, Virginia Mason Medical Center, PO Box 900 (C6-GSUR), Seattle, WA 98111

Background. Patients who present with malignant esophagorespiratory fistula continue to provide a significant palliative challenge to gastroenterologists and surgeons.

Methods. This retrospective series reviewed 29 patients treated with conventional prostheses (13 patients), expandable wire mesh-coated prostheses (12 patients), and surgical bypass with esophageal exclusion (4 patients) between 1982 and 1995.

Results. Improvement in dysphagia scores were comparable in all three groups. Fistula occlusion was more successful with expandable prostheses (92%) compared conventional prostheses (77%); however, reinterventions were required more commonly with expandable prostheses, which were also significantly more expensive on a unit cost basis. In selected patients in whom prosthesis placement either was inappropriate or failed, surgical bypass and esophageal exclusion was undertaken. These patients demonstrated good palliation with minimal morbidity and no mortality.

Conclusions. Both conventional and expandable prostheses are safe and reasonably straightforward treatment modalities for patients with esophagorespiratory fistulas. Because of ease of insertion and large luminal diameter, expandable metal prostheses will see increasing use in treatment of these difficult patients; however, conventional prostheses will remain a good alternative, especially in patients with extrinsic esophageal compression. When stent placement is either unsuccessful or inadvisable, physiologically fit patients can undergo surgical bypass and esophageal exclusion with good palliation and minimal morbidity and mortality.

This article has been cited by other articles:

				H. K. Kim, Y. S. Choi, K. Kim, J. Kim, and Y. M. Shim Long-term results of surgical treatment in benign bronchoesophageal fistula J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 411 - 414. [Abstract] [Full Text] [PDF]

				T. H. Baron Expandable Metal Stents for the Treatment of Cancerous Obstruction of the Gastrointestinal Tract N. Engl. J. Med., May 31, 2001; 344(22): 1681 - 1687. [Full Text] [PDF]