Tracheoscopic Management of Postoperative High Tracheoesophageal Fistula Using Covered Self-Expanding Metallic Stents: A Comparative Report of 2 Cases With Divergent Outcomes.
Xiaodong Pang, Yili Chen, Yue Liu et al.
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Case in brief
Two men developed high tracheoesophageal fistulas after esophageal cancer surgery. In the 67-year-old, a 0.6 cm fistula 4 cm below the vocal folds was treated with a straight covered self-expanding metallic stent; after mucosal healing and epithelialization were confirmed, it was removed when granulation tissue hyperplasia was observed. In the 78-year-old man with diabetes, a larger 12×8 mm fistula 3 cm below the vocal folds was complicated by repeated stent displacement and impaired healing. A customized ball-ended stent, adjunctive materials, and ultimately external percutaneous fixation were used to stabilize it.
What made this case unusual
The contrasting courses illustrate the technical difficulty of stenting fistulas close to the vocal folds: a straight stent was successful in one case, whereas the other required a customized stent and external fixation after repeated displacement.
Diagnostic / clinical pearl
For high postoperative tracheoesophageal fistulas in the subglottic region, stent choice and adjunctive stabilization may need to be individualized when migration occurs.