Reshaping the Patient’s Airway: Friendship Hospital’s Stent Placement Technique Offers Hope for Esophageal-Tracheal Fistula Patients

Recently, Friendship Hospital’s Respiratory Medicine Department successfully treated a patient with esophageal cancer complicated by esophageal-tracheal fistula, using advanced stent placement techniques to seal the fistula and resolve critical issues such as aspiration, choking, and lung infections. This breakthrough approach allowed the patient to regain the ability to eat and breathe comfortably.

Case Overview

The patient, a 62-year-old male, had a 10-year history of esophageal cancer and had undergone chemotherapy and radiation. Despite treatment, his tumor continued to progress, resulting in an esophageal-tracheal fistula and aspiration pneumonia. The patient was experiencing severe coughing, fever, and difficulty swallowing, which led to a condition known as "feeding fear," causing him to avoid food and drink. This drastically reduced his nutritional intake, leading to rapid weight loss and physical deterioration.

Upon admission, the Respiratory Medicine Department initiated a comprehensive treatment plan, including withholding food and water and placing a jejunal feeding tube in collaboration with the Gastroenterology Department to provide nutritional support. Given the complexity of the fistula, surgical repair was deemed too risky, especially for a patient weakened by radiation and chemotherapy. After careful consideration, stent placement was chosen as a minimally invasive, highly effective solution.

Dr. Yan Fugui and Dr. Wu Yanjun successfully performed the procedure under general anesthesia, using a rigid bronchoscope to insert a metal-covered stent to seal the fistula. The operation was a success, with no complications, and the patient’s recovery progressed smoothly.

What is Esophageal-Tracheal Fistula?

An esophageal-tracheal fistula is a rare but serious complication in some esophageal cancer patients. It occurs when an abnormal passage forms between the esophagus and trachea, often caused by tumor growth or other factors. Normally, these two structures are separate, but when a fistula develops, food can enter the lungs, leading to aspiration pneumonia. This is a life-threatening condition that can severely impact the patient’s ability to eat and breathe.

How Does the Stent Work?

Physical Blockage: The stent acts like a "patch," covering the fistula and blocking the leakage of food and secretions from the esophagus into the trachea.
Supporting Airway: In cases where the airway is narrowed due to tumor pressure, the stent also helps to expand the airway, ensuring the patient can breathe freely.

What to Expect After Stent Placement?

Stent placement is a crucial step in treating the fistula, but postoperative care is equally important:

• Promoting Mucus Clearance: As the stent may cause some irritation in the airways initially, patients are advised to learn how to cough effectively and expel mucus with the help of medical staff. Nebulizer treatments may also be used to keep the airway clear.
• Nutritional Support: After sealing the fistula, patients will continue receiving nutrition via a nasogastric tube or a gastrostomy tube to support their recovery.
• Regular Follow-up: Periodic bronchoscopy is needed to check for stent displacement, new tissue growth, or mucus blockages, allowing timely intervention if necessary.
• Long-term Monitoring: While the stent offers palliative relief and improves quality of life, it does not treat the underlying esophageal cancer. Patients will still need comprehensive cancer treatment.

Esophageal-tracheal fistula is a daunting complication for esophageal cancer patients, but it is not an insurmountable challenge. The stent placement technique provides a minimally invasive, quick, and effective solution, offering a lifeline to patients. It not only seals the fistula and relieves symptoms but also restores the patient’s ability to eat and breathe, allowing them to regain dignity and quality of life.

About Friendship Hospital’s Respiratory Medicine Department

With over 30 years of experience in bronchoscopy, Friendship Hospital’s Respiratory Medicine Department is equipped with advanced technology such as rigid bronchoscopy, electronic bronchoscopy, cryotherapy, laser therapy, and endoscopic ultrasound. The department boasts a skilled and experienced medical team that continuously strives to improve treatment methods and provide high-quality care for patients with respiratory diseases.