Gastroenterological Endoscopy by Michael B. Wallace Paul Fockens Joseph Jao-Yiu Sung

Author:Michael B. Wallace,Paul Fockens,Joseph Jao-Yiu Sung
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2018-01-08T00:00:00+00:00

27.2.5 Esophagorespiratory Fistulas

Fistulas between the gastrointestinal and respiratory tracts are sometimes encountered in patients with advanced esophageal cancer as a complication of radiation therapy, chemotherapy, or in the setting of advanced disease. Coughing, recurrent aspiration, fever, dysphagia, and pneumonia are the most common presenting symptoms, and diagnosis can be made by fluoroscopic or CT imaging, or by direct endoscopic or bronchoscopic visualization53 (Fig. 27.7). The most common fistulas, esophagotracheal (tracheoesophageal [TEF]) account for over 50% of fistulas, but esophagobronchial or esophagopulmonary fistulas (communication through lung parenchyma) can also occur.54 TEF develop in about 5 to 15% of patients with esophageal cancer, and much less commonly (< 1%) in patients with bronchogenic carcinoma.55 Patients with esophagorespiratory fistulae have an average survival of less than 6 weeks with supportive care alone.54 Surgical approaches via esophageal bypass or diversion carry a very high complication and mortality rate, and for those reasons are now rarely performed. Instead, esophagorespiratory fistulas are most commonly managed by interventional modalities, such as esophageal and/or respiratory stents, clips, or suture placement.56

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