Tracheoscopic Management of Postoperative High Tracheoesophageal Fistula Using Covered Self-Expanding Metallic Stents: A Comparative Report of 2 Cases With Divergent Outcomes
Abstract
Case series Patient: Male, 67-year-old • Male, 78-year-old Final Diagnosis: Postoperative high tracheoesophageal fistula Symptoms: Difficulty in swallowing Clinical Procedure: — Specialty: Pulmonology • Surgery Objective: Unusual clinical course Background Tracheoesophageal fistula (TEF) following esophageal cancer resection is a rare but life-threatening complication. Management of high postoperative TEF, particularly in the subglottic region, presents significant technical challenges due to anatomical constraints and the risk of stent migration. This report evaluates the efficacy of tracheoscopic placement of covered self-expanding metallic stents (CSEMS) for treating high postoperative TEF. Case Reports We report 2 cases of high TEF complicating esophageal cancer surgery. Case 1: A 67-year-old man with a 0.6 cm diameter fistula located 4 cm distal to the vocal folds. A straight CSEMS was successfully deployed. Four months later, after confirmation of complete mucosal healing and epithelialization, the stent was removed following the observation of granulation tissue hyperplasia. Case 2: A 78-year-old man with diabetes presented with a large (12 × 8 mm) fistula situated 3 cm distal to the vocal folds. An initial straight CSEMS failed due to repeated displacement. It was replaced with a customized ball-ended CSEMS and supplemented with biogel and gelatin sponges. Due to refractory displacement and impaired healing, external percutaneous fixation was ultimately used to stabilize the stent. Conclusions Tracheoscopic CSEMS placement represents a viable management strategy for high postoperative TEF. However, successful outcomes in the challenging subglottic region are highly dependent on individualized stent selection and adjunctive measures, as illustrated by the contrasting courses of our 2 cases. These experiences underscore the importance of technical adaptability, while larger studies are needed to define optimal management algorithms.