Double stenting for malignant airway and esophageal obstructions

This study evaluated the effects of double stenting as a palliative measure in patients with advanced esophageal and bronchogenic carcinomas. We performed a retrospective analysis of hospital records for consecutive patients that underwent airway and esophageal stenting, due to advanced bronchogenic or esophageal carcinoma. All patients were assessed for dyspnea, dysphagia, and performance status before and after the procedure. Between 2003 and 2015, 44 patients underwent double stenting. Stents were typically partially covered self-expandable metallic stents (PCSEMS) for the esophagus and SEMS or silicone Y-stents for the airway. Twenty-six patients had esophago-airway fistulas (OAFs). Eighteen patients received the procedure due to airway and esophageal obstructions. Primary tumors were esophageal cancer in 39 patients and bronchogenic carcinoma in five patients. The procedure produced significant reductions in the dyspnea score (2.3 vs. 0.2, P < 0.00001), the dysphagia score (2.54 vs. 0.8, P < 0.00001), and performance status (54 vs. 66.5, P < 0.00001). No intraoperative deaths occurred. Four patients had early complications, including respiratory insufficiency that required ventilatory support (two patients), perforation of the right main bronchus (one patient), and fatal hemorrhage 3 days after stenting (one patient). Fifteen patients had late complications, including fatal hemorrhage (six patients with OAFs) and dyspnea or dysphagia that required endoscopic re-intervention (nine patients). Mean survival times were 78.4 days in esophageal cancer and 70.8 days in bronchial carcinoma. Double stenting was an effective palliative treatment for dysphagia and dyspnea caused by advanced esophageal or bronchogenic carcinoma.