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The Utility of Stenting in the Treatment of Airway Gastric Fistula After Esophagectomy for Esophageal Cancer

Background:The purpose of this study was to determine the overall efficacy of airway stenting in the treatment of patients developing airway gastric fistula (AGF) after esophagectomy. Methods:MEDLINE/PubMed search from January 1990 to November 2011 was conducted using the search terms “esophageal cancer,” “esophagectomy,” “airway fistula,” “tracheal fistula,” “bronchial fistula,” and “stent” alone and in combination. The authors identified 2 case series and 8 case reports. All case series and reports were reviewed to include the number of patients, the type of stent utilized, the location of AGF (tracheal or bronchial), the overall success in closure, recurrence (to include time to recurrence), and outcome if available. The Mantel-Haenszel analysis was performed on the basis of the type of stent and location of the AGF as it related to efficacy and outcome. Conclusions:AGF after esophagectomy for esophageal cancer is rare. Although surgical repair offers definitive treatment, the operative risk in such patients is high. With a nonsurgical approach, an analysis of available case reports/series suggests a trend toward more durable closure of AGF with the utilization of covered metallic stents and when the fistula is bronchial in origin. Despite a high recurrence rate (39%), stenting may provide temporization until surgery can be tolerated. Airway stenting for AGF should not be considered as a definitive therapy and when utilized it requires frequent reassessment for recurrence.