Background
Esophageal self-expandable stents (SESs) effectively treat strictures and leaks but
may be complicated by a stent-associated esophagorespiratory fistula (SERF). Little
is known about SERFs.
Objective
To determine the incidence, morbidity, mortality, and risk factors for SERF.
Design
Retrospective case-control study.
Setting
Single referral center.
Patients
All adults undergoing esophageal SES placement during a 10-year period.
Intervention
Stent placement.
Main Outcome Measurements
Occurrence of SERF, morbidity, and mortality.
Results
A total of 16 of 397 (4.0%) patients developed SERF at a median of 5 months after
stent placement (range 0.4-53 months) including 6 of 94 (6%), 10 of 71 (14%), and
0 of 232 (0%) of those with lesions in the proximal, middle, and distal esophagus,
respectively (overall P < .001). SERF occurred in 10% of those with proximal and mid-esophageal lesions,
including 14% with benign strictures, 9% with malignant strictures, and none with
other indications for SES placement (P = .27). The risk was highest (18%) in patients with benign anastomotic strictures.
Risk factors for development of SERF included a higher Charlson comorbidity index
score (odds ratio [OR] 1.47 for every 1-point increase; P = .04) and history of radiation therapy (OR 9.41; P = .03). Morbidity associated with SERF included need for lifelong feeding tubes in
11 of 22 (50%) and/or tracheostomy or mechanical ventilation in 5 of 22 (23%). Median
survival after diagnosis was 4.5 months (range 0.35-67), and 7 patients survived less
than 30 days.
Limitations
Retrospective design, limited statistical power.
Conclusion
SERF is a morbid complication of SES placement for strictures of the proximal and
mid-esophagus. The dominant risk factors for development of SERF are prior radiation
therapy and comorbidity score.
Abbreviations:
ERF (esophagorespiratory fistula), SERF (stent-associated ERF), SES (self-expandable stent)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 13, 2012
Accepted:
October 3,
2012
Received:
May 4,
2012
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 280.
If you would like to chat with an author of this article, you may contact Dr Topazian at [email protected]
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
