Tracheal and oesophageal stenting for carcinoma of the upper oesophagus invading the tracheo-bronchial tree

doi:10.1016/S0009-9260(98)80320-6

Clinical Radiology

Volume 53, Issue 10, October 1998, Pages 760-763

https://doi.org/10.1016/S0009-9260(98)80320-6 Get rights and content

Two cases of combined tracheal and oesophageal stenting for carcinoma of the upper oesophagus invading the tracheo-bronchial tree are described. Case 1 describes the complication of respiratory distress following insertion of a high oesophageal stent. This caused severe stridor which required tracheal stenting. In case 2 prophylactic stenting of the airway prior to oesophageal stenting was performed as a staging CT demonstrated severe compromise of the distal trachea/bronchus in a patient who was experiencing both dysphagia and dyspnoea. In both cases the respiratory and dyspnoeic symptoms were relieved.

These cases illustrate the effective use of tracheal/bronchial and oesophageal metal stents in palliating patients with combined respiratory and dysphagic symptoms secondary to oesophageal malignancy.

When treating high oesophageal tumours tracheal compromise should be considered and prophylactic stenting of the airway prior to oesophageal stenting performed to avoid further airway compromise when the oesophageal stent expands.

References (11)

TanBS et al.
Review. Minimally invasive therapy for advanced oesophageal malignancy
Clinical Radiology
(1996)
ColtHG et al.
Airway stents. Present and future
Clinical Chest Medicine
(1995)
CwikielW et al.
Malignant oesophageal strictures: treatment with self-expanding Nitinol stent
Radiology
(1993)
WatkinsonAF et al.
Oesophageal carcinoma: initial results of palliative treatment with covered self-expanding endoprostheses
Radiology
(1995)
SongHY et al.
Oesophageal strictures: treatment with a new design of modified Gianturco stent
Radiology
(1992)

There are more references available in the full text version of this article.

Cited by (26)

Direct Erosion and Prolapse of Esophageal Stents into the Tracheobronchial Tree Leading to Life-threatening Airway Compromise
2009, Journal of Vascular and Interventional Radiology
Citation Excerpt :
Concurrent tracheobronchial and esophageal stent placement can effectively alleviate both dysphagia and airway contamination in cases of malignant tracheoesophageal communications (13). Hence, esophageal stent placement combined with prophylactic tracheobronchial stent placement to secure the airway can be a worthwhile option when the volume and extent of the disease increases the likelihood of erosion and fistulization (14). However, parallel esophageal and tracheal stent placement with Gianturco-Rosch Z self-expanding metal stents (Cook Medical, Bloomington, Indiana) has been incriminated for fatal hemorrhage, presumably due to the high radial forces of the particular devices (15).
Covered or uncovered self-expanding metal stents are currently used for the palliative treatment of neoplastic esophageal obstructions or compressions and malignant esophageal leaks or fistulas. This small series, from three different European hospitals, highlights the unusual but significant complication of esophageal stent perforation followed by erosion and prolapse of the endoprosthesis into the tracheobronchial tree causing acute airway compromise or aspiration. Possible causal mechanisms and means of treatment are discussed to raise physician awareness of this life-threatening complication.
Management of airway involvement of oesophageal cancer using covered retrievable nitinol stents
2009, Clinical Radiology
Citation Excerpt :
Although covered stents have several disadvantages, including high migration rate, low mucociliary clearance, and high sputum retention, their removability in patients with stent-related complications makes them, on balance, more advantageous than uncovered.12 Although there have been several studies of airway stent placement in patients with airway involvement of oesophageal cancer,5–10,12–24 little is known about the safety and efficacy of fluoroscopically guided placement of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement. Therefore, the aim of the present study was to evaluate the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with malignant airway stricture and/or ERF.
To assess the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement.
Under fluoroscopic guidance, covered retrievable nitinol airway stents were placed in 23 oesophageal cancer patients with airway stricture and/or oesophagorespiratory fistula (ERF) over a long period of 12 years. Six patients only had aspiration by ERF and three patients had both airway stricture and asymptomatic ERF. Technical aspects, dyspnoea improvement, and/or resolution of ERF symptoms, complications, reinterventions, and survival data were evaluated.
A total of 27 airway stents (14 tracheal, 11 bronchial, and two hinged) were placed successfully in 23 patients with airway stricture or ERF. Dyspnoea score decreased significantly after stent placement (p < 0.001). ERF were sealed off in all nine patients. Complications included stent migration or expectoration (n = 4), haemoptysis (n = 2), sputum retention (n = 7), and tumour overgrowth (n = 1). All three migrated stents were easily removed. Twenty-one patients died, with the median survival period of 76 days (range 2–197 days).
Placement of covered retrievable expandable nitinol stents was safe and effective for the palliative treatment of airway strictures and/or ERF, with a reasonable range of complications, in patients with advanced oesophageal cancer.
Volume CT: recent advances in acquired abnormalities of the trachea
2007, Annales d'Oto-Laryngologie et de Chirurgie Cervico-Faciale
Présenter les évolutions récentes de l'imagerie par tomodensitométrie (TDM) de la trachée. Cet article sera centré sur les apports majeurs de la TDM multibarrette ou multidétecteur.
La TDM multibarrette, introduite au début des années 2000, permet d'acquérir les données d'imagerie de l'ensemble des voies aériennes en quelques secondes, tout en maîtrisant la dose d'irradiation en raison du fort contraste naturel entre l'air intratrachéal et la paroi trachéale.
L'acquisition TDM multibarrette étant volumique et les voxels isotropes, les reconstructions multiplanaires dans l'axe principal de la trachée, ou 3D, incluant l'endoscopie virtuelle, offrent une excellente résolution anatomique, améliorant les capacités de détection et de localisation du scanner, pour préparer ou contrôler le geste endoscopique ou chirurgical. La rapidité d'acquisition permet d'obtenir les images durant un effort d'expiration, apportant une dimension dynamique à l'exploration de l'arbre trachéobronchique principal, très utile au diagnostic de trachéomalacie.
La TDM multibarrette est une technique d'imagerie non invasive de la trachée dont les applications sont nombreuses : mise en évidence de pathologies trachéales anatomiques ou fonctionnelles, bilan d'extension local et locorégional, préparation et contrôle des gestes endoscopiques et chirurgicaux.
To show the recent improvements in CT imaging of the trachea due to the introduction of multidetector computed tomography (MDCT).
MDCT technology, which was introduced in the early 00's, allows acquiring the entire airways within few seconds while using low dose parameters thanks to the natural high contrast of the airways.
Volume acquisition with isotropic voxels offers an excellent anatomical resolution in all directions, improving the quality of multiplanar reformations and 3D reconstructions, including virtual bronchoscopy. Therefore, the ability of CT for detecting and localizing tracheal abnormalities are improved, which is useful for planning endoscopy or open surgery, or assess their results. Dynamic acquisition during expiration is the last refinement permitted by MDCT, which is of value to detect tracheomalacia.
MDCT is a non-invasive technique to image the trachea. Its applications are numerous, such as depiction of anatomical or functional abnormalities, evaluation of local extent of the disease, planning and assessing open surgery or interventional endoscopy.
Minimizing Endoscopic Complications: Endoluminal Stents
2007, Gastrointestinal Endoscopy Clinics of North America
Citation Excerpt :
Nonetheless, it may be worthwhile to perform this maneuver if there is any suspicion that there may be airway compromise. If it is felt that the patient may be at risk for airway compromise, the procedure should be delayed and consideration made for airway evaluation and tracheobronchial stent placement before esophageal stent placement [7]. If sudden stridor develops immediately after stent deployment, there are two options.
Almost all endoluminal stents used by gastroenterologists in the United States are self-expandable metal stents, and they are placed most commonly for relief of malignant luminal obstruction. Recently, a plastic self-expandable stent was approved for treating refractory benign esophageal strictures. Endoluminal stent placement is associated with myriad of complications. Some of these complications can be avoided or minimized by the endoscopist, whereas others are beyond the endoscopist's control. This article covers the various complications that can occur following self-expandable stent placement and provides recommendations on how to minimize these complications.
Use of metallic stents and balloons in the esophagus and gastrointestinal tract
2001, Journal of Vascular and Interventional Radiology
Placement of conventional and expandable stents for malignant esophageal stenoses
2001, Techniques in Gastrointestinal Endoscopy
The disease of a majority of patients with esophageal cancer is not curable because of an advanced stage of tumor or development of recurrence after curative therapy. Palliation of dysphagia with endoscopic stent placement offers a rapid and usually long-lasting relief. Endoscopic stent placement is the treatment of choice for occlusion of esophagorespiratory fistulas. Conventional endoprostheses have some limitations, such as a high perforation rate with insertion in 6% to 8% and obstruction in 5% to 10%. Self-expandable metallic stents (SEMS) have overcome the drawbacks of plastic endoprostheses because of easier insertion resulting in a perforation rate approximating 1% to 2%. The major disadvantages of SEMS include high cost, tendency for tumor ingrowth, and stent migration. The choice between a plastic and metallic endoprosthesis must be individualized contingent on tightness, angulation, and location of the tumor, although realistically over 90% of stents placed in the Western world are now metallic. The future for endoscopic stenting appears promising with the development of different alloys and mechanical designs to facilitate placement and reduce the incidence of complications.

View all citing articles on Scopus

View full text

Tracheal and oesophageal stenting for carcinoma of the upper oesophagus invading the tracheo-bronchial tree

Clinical Radiology

Clinical Chest Medicine

Malignant oesophageal strictures: treatment with self-expanding Nitinol stent

Radiology

Oesophageal carcinoma: initial results of palliative treatment with covered self-expanding endoprostheses

Radiology

Oesophageal strictures: treatment with a new design of modified Gianturco stent

Radiology