TREATMENT OF MALIGNANT ESOPHAGORESPIRATORY FISTULAS WITH SILICONE-COVERED METALLIC Z-STENTS

PURPOSE: To prospectively evaluate the clinical efficacy of covered metallic Z stents in the treatment of esophagorespiratory fistulas (ERFs). PATIENTS AND METHODS: Twelve patients with severe aspiration symptoms from malignant ERFs were treated with silicone-covered, metallic, self-expanding Gianturco-Rosch Z (GRZ) stents. RESULTS: Fluoroscopically guided stent placement was successful and well tolerated in all patients. Immediate postprocedural endoscopy and esophagography showed excellent coverage of the fistulas in all cases, Aspiration symptoms were completely relieved in eight of 12 patients (67%), Four of 12 patients (33%) were improved and able to eat a soft diet, There were no stent-related deaths, Nine patients have died and three patients are alive, Mean follow-up for the entire group was 3.9 months (range, 1 week to 10.5 months), Nonfatal complications occurred in three of 12 patients (25%), Complications included one membrane disruption and one granulomatous reaction with a slight upward stent migration. CONCLUSION: GRZ stents are an effective and safe means of palliation in patients with malignant esophagorespiratory fistulas.