Several types of oesophageal prosthesis have been used in an attempt to seal the fistula with varying results [1 , 3—5]. Tissue glues and amino acid solutions have been instilled in small fistula with some success  but they can cause obstruction of the respiratory tree due to their sealing effect . Conventional oesophageal prostheses are suitable for tracheoesphageal fistula with a stenotic tumour but often migrate and allow food to track into the fistula in a normal sized oesophagus [1 , 3]. Covered self-expanding stents have been used to successfully treat malignant tracheoesophageal fistula  but may prove to be unsuccessful in a dilated oesophagus as in our case.
The use of Wilson—Cook prosthesis was first described by Lux and Wilson  and soon after by Irving and Simpson  in oesophageal fistula with good results. In our case the oesophageal tumour was at first stented with a covered stent, deterioration in symptoms lead to a gastrograffin swallow, which revealed a treacheoesophageal fistula.
Whether the fistula existed prior to intubation or if the stent was the cause remains an unanswered question. The oesophagus was dilated to at least twice the size of the stent. Interestingly the stent had not migrated and the problem was not migration of the stent but the large lumen of the oesophagus allowing food to pass into the fistula. Removal of the previous prosthesis and stenting with a modified Wilson—Cook stent above the level of dilated oesophagus successfully obliterated the fistula.
Our report demonstrates that the use of this prosthesis may lead to successful palliation in seemingly difficult cases of tracheoesophageal fistulae. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In.
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Management of a difficult malignant tracheoesophageal fistula Abhiram Sharma. Oxford Academic.
Google Scholar. Mazhar U. Michael E. Article history. Revision Received:. Cite Citation. Permissions Icon Permissions. Abstract Malignant tracheoesophageal fistula is a pre terminal condition in oesophageal cancer and is associated with significant patient distress. Tracheoesophageal fistula , Wilson—Cook prosthesis , Oesophageal stent. View large Download slide. Successful endoscopic sealing of malignant esophageotracheal fistulae by using a covered self-expandable stenting system. Search ADS. Lacey Smith.
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Improved palliation of a respiratory-esophageal fistula with a cuffed esophageal prosthesis. A new cuffed oesophageal prosthesis for the management of malignant oesophago-respiratory fistula. Cuffed esophageal prosthesis: a useful device in desperate situations in esophageal malignancy. Issue Section:. Download all figures. Comments 0. Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions.
Add comment Cancel. Submit a comment. Comment title. You have entered an invalid code. Submit Cancel. Thank you for submitting a comment on this article. Your comment will be reviewed and published at the journal's discretion. Please check for further notifications by email. View Metrics. For example, he says he did not like having to ask his year-old daughter to do general chores around the house that on a typical day were his responsibility.
Tinnes found an additional source of support through Imerman Angels , a program he learned about from the American Cancer Society.
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The program pairs cancer patients and caregivers with a trained volunteer who has been through a similar experience. Tinnes, who lives in New Jersey, spoke several times with an esophagus cancer survivor from Kentucky who also had his esophagus removed.
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He gave Tinnes a heads-up about surgery side effects. I'm going to do whatever I need to do to get better. Esophageal cancer is life changing, in many ways. But with support and patience one can lead a normal, thriving life. Still, he says, he has good days and bad days. If you need help or information, please call us at or use live chat for the quickest response.
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American Cancer Society news stories are copyrighted material and are not intended to be used as press releases. Category Latest News. Esophageal Cancer Survivor Moving Forward. Help and support Tinnes said his wife and daughter have helped him through a lot of his recovery, but that depending on others for help has not come easily.
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