Stent-associated esophagorespiratory fistulas: incidence and risk factors

详细信息    查看全文

• 作者：Benjamin L. Bick ; MD¹ ; Louis M. Wong Kee Song ; MD² ; Navtej S. Buttar ; MD² ; Todd H. Baron ; MD² ; Francis C. Nichols ; MD³ ; Fabien Maldonado ; MD⁴ ; David A. Katzka ; MD² ; Felicity T. Enders ; PhD⁵ ; Mark D. Topazian ; MD² ;
• 关键词：ERF ; esophagorespiratory fistula ; SERF ; stent-associated ERF ; SES ; self-expandable stent
• 刊名：Gastrointestinal Endoscopy
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：77
• 期：2
• 页码：181-189
• 全文大小：888 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

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.