Treatment difficulties of malignant esophagorespiratory fistula: Case report of a 56-year-old patient with esophageal cancer
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Department of Oncology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Clinic of Internal Medicine, Gastroenterology and Hepatology with the Unit of Cardiology, Heart Failure Treatment Centre and Cardio-Oncology, Clinical University Hospital, Olsztyn, Poland
Department of Internal Medicine, Gastroenterology, Cardiology and Infectionology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Internal Medicine Ward with Oncology Diagnostics and Cardiology Subdivision, SP ZOZ MSW with Oncology Center of Warmia and Mazury, Olsztyn, Poland
Maciej Zechowicz   

Department of Oncology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Wojska Polskiego 37, 10-228 Olsztyn, Poland. Tel.: +48 604 451 043; fax: +48 89 524 53 89.
Submission date: 2016-01-27
Acceptance date: 2016-04-14
Online publication date: 2016-05-05
Publication date: 2020-03-24
Pol. Ann. Med. 2016;23(2):177–181
An esophagorespiratory fistula (ERF) is a lethal complication of advanced esophageal cancer. The preferred treatment method is placing a self-expanding stent, which is expected to decrease the risk of life-threatening complications.

In the case study we present a patient with esophageal cancer complicated with the presence of ERF, pneumonia, lung abscess and severe malnutrition.

Case study:
A 56-year old man was hospitalized due to short syncope, dyspnea and cough. Cachexia was apparent. Immediate diagnostics with chest X-ray, bronchoscopy, gastroscopy and computed tomography (CT) of the chest revealed esophageal cancer and presence of ERF with respiratory complications. Endoscopic stent placement significantly decreased the initial symptoms. The patient was later re-admitted due to recurrent respiratory infections, dysphagia and progressing cachexia. He required stent placement again, parenteral limentation and prolonged antibiotic therapy. From the diagnosis he survived 28 weeks.

Results and discussion:
The average survival of patients with diagnosed ERF is about 8 weeks. The palliative treatment is expected to reduce bronchial aspirations and to prevent dysphagia. The recommended method is the insertion of esophageal stent to unblock the gastrointestinal tract and to close the fistula simultaneously. Reopening of the ERF is a severe complication caused mostly by progressing neoplasm. Successful surgical treatment of primary or recurrent fistulas is only probable in patients with good or moderate performance status.

An immediate implementation of diagnostic and therapeutic methods is necessary, as the time to diagnosis and treatment of a malignant fistula strongly influences the patient's survival and quality of life.

The authors declare no conflict of interest.
Wojciechowska U, Didkowska J. Cancer morbidity and mortality in Poland. The National Cancer Registry at the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology. Access 29.07.15 [in Polish].
Pennathur A, Gibson M, Jobe B, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381(9864):400–412.
Berry M. Esophageal cancer: staging system and guidelines for staging and treatment. J Thorac Dis. 2014;6(suppl 3):S289–S297.
Shin JH, Kim JH, Song HY. Interventional management of esophagorespiratory fistula. Korean J Radiol. 2010;11(2):133–140.
Elbe P, Lindblad M, Tsai J, et al. Non-malignant respiratory tract fistula from the esophagus. A lethal condition for which novel therapeutic options are emerging. Interact Cardiovasc Thorac Surg. 2013;16(3):257–262.
Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, Sung KB. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology. 2004;232(1):252–259.
Seto Y, Yamada K, Fukuda T, et al. Esophageal bypass using a gastric tube and a cardiostomy for malignant esophagorespiratory fistula. Am J Surg. 2007;193(6):792–793.
Choi MK, Park YH, Hong JY, et al. Clinical implications of esophagorespiratory fistula in patients with esophageal squamous cell carcinoma (SCCA). Med Oncol. 2010;27(4):1234–1238.
Turkyilmaz A, Aydin Y, Eroglu A, Bilen Y, Karaoglanoglu N. Palliative management of esophagorespiratory fistula in esophageal malignancy. Surg Laparosc Endosc Percutan Tech. 2009;19(5):364–367.
Ross WA, Alkassab F, Lynch PM, et al. Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas. Gastrointest Endosc. 2007;65(1):70–76.
Tomaselli F, Maier A, Sankin O, Pinter H, Smolle J, Smolle-Jüttner FM. Ultraflex stent-benefits and risks in ultimate palliation of advanced, malignant stenosis in the esophagus. Hepatogastroenterology. 2004;51(58):1021–1026.
Adler DG, Baron TH, Geels W, Morgan DE, Monkemuller KE. Placement of PEG tubes through previously placed self-expanding esophageal metal stents. Gastrointest Endosc. 2001;54(2):237–241.
Reed MF, Mathisen DJ. Tracheoesophagealfistula. Chest Surg Clin N Am. 2003;13(2):271–289.
Hamai Y, Hihara J, Emi M, Aoki Y, Miyata Y, Okada M. Airway stenting for malignant respiratory complications in esophageal cancer. Anticancer Res. 2012;32(5):1785–1790.
Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg. 2008;34(5):1103–1107.