Esophagorespiratory Fistula Without Stricture: Palliative Treatment with a Barbed Covered Metallic Stent in the Central Airway

PURPOSE: To compare the clinical safety and efficacy of airway placement of barbed and nonbarbed metallic stents in the treatment of esophagorespiratory fistula (ERF) without stricture. MATERIALS AND METHODS: The authors prospectively evaluated the clinical results of 10 patients who underwent fluoroscopically guided placement of barbed, fully covered, retrievable metallic stents in the trachea or main bronchus for treatment of ERF without stricture in the esophagus and central airway between 2007 and 2009. The authors compared these outcomes with retrospectively evaluated clinical outcomes in seven patients who underwent airway placement of nonbarbed, fully covered, metallic stents for treatment of ERF without stricture between 1998 and 2001. Study end points included stent migration and clinical success, defined as effective closure of the fistula with improved aspiration symptoms, or improvement of dyspnea, within 7 days after stent placement. RESULTS: Clinical success was observed in nine of ten (90%) of patients who received barbed steins, compared with two of seven (29%) who were treated with nonbarbed stents (P = .035). Stent migration within 5 days occurred in zero of ten and five of seven (57%) patients, respectively (P = .015). CONCLUSIONS: Placement of barbed, covered metallic stents in the central airway is safe and effective for closure of ERF without strictures. The barbed design is effective in preventing stent migration.