BACKGROUND: Postradiotherapy or malignant esophagotracheal fistulas still represent a dilemma. In the absence of surgical options attempts are made to close the fistula endoscopically by means of esophageal and/or tracheal stents. Tracheal stent placement in laryngectomy patients with terminal stomas is particularly problematic due to the risk of stent dislocation during cannula replacement PATIENTS AND METHODS: Six laryngectomy patients with high esophagotracheal fistulas were each fitted with a coated Ultraflex stent (Boston Scientific, Watertown/MA, US). Following skin undermining, the stents were fixed to the tracheostoma with interrupted sutures and the skin flaps attached to the stent with a second row of sutures. RESULTS: Fistulas could be completely closed in all patients and there were no cases of stent dislocation. Cannula replacement was unproblematic. CONCLUSIONS: Suture fixation of tracheal stents is a viable procedure even for patients with esophagotracheal fistulas and terminal tracheostomy following laryngectomy.
BACKGROUND: Postradiotherapy or malignant esophagotracheal fistulas still represent a dilemma. In the absence of surgical options attempts are made to close the fistula endoscopically by means of esophageal and/or tracheal stents. Tracheal stent placement in laryngectomy patients with terminal stomas is particularly problematic due to the risk of stent dislocation during cannula replacement PATIENTS AND METHODS: Six laryngectomy patients with high esophagotracheal fistulas were each fitted with a coated Ultraflex stent (Boston Scientific, Watertown/MA, US). Following skin undermining, the stents were fixed to the tracheostoma with interrupted sutures and the skin flaps attached to the stent with a second row of sutures. RESULTS:Fistulas could be completely closed in all patients and there were no cases of stent dislocation. Cannula replacement was unproblematic. CONCLUSIONS: Suture fixation of tracheal stents is a viable procedure even for patients with esophagotracheal fistulas and terminal tracheostomy following laryngectomy.
Authors: William A Ross; Firas Alkassab; Patrick M Lynch; Gregory D Ayers; Jaffer Ajani; Jeffrey H Lee; Mike Bismar Journal: Gastrointest Endosc Date: 2007-01 Impact factor: 9.427