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Aerodigestive fistula (ADF) is defined as a pathological connection between the upper digestive tract and the airway. ADF is associated with high morbidity and mortality and management is often complex. A cohort study including all patients admitted with ADF 2004–2022 at a single tertiary esophageal surgery center was performed based on prospectively collected administrative data and retrospectively collected electronic patient chart data,. Patient demographics, performance status, comorbidity, fistula characteristics, management, and outcomes in terms of morbidity and mortality were assessed in patients with ADF of three distinct types: (i) tumor overgrowth-related, (ii) various benign etiologies, and (iii) post-esophagectomy. Sixty-one patients with ADF were included in the study, 33 (54.1%) tumor overgrowth-related, six (9.8%) benign and 22 (36.1%) post-esophagectomy. In the post-esophagectomy group 15 out of 22 (68.2%) patients were diagnosed with anastomotic leakage prior to ADF diagnosis. Self-expandable metallic stents (SEMS) were used for temporary fistula sealing in 59 out of 61 (96.7%) patients, of which most received stents in both the digestive tract and airway. Temporary fistula sealing with stents was successful enabling discharge from hospital in 47 out of 59 (79.7%) patients. Definitive ADF repair was performed in 16 (26.2%) patients, of which one (6.3%) died within 90-days and 15 could be discharged home with permanently sealed fistulas. ADF is a complex condition associated with high mortality, which often requires multiple advanced interventions. SEMS can be applied in the airway and simultaneously in the digestive tract to temporarily seal the ADF as bridge to definitive surgical repair. [ABSTRACT FROM AUTHOR]

Background: The use of duckbill-type anti-reflux metal stents (DMS) in reinterventions after covered metal stent (CMS) dysfunction has been reported in patients with distal malignant biliary obstruction (MBO). However, the superiority of DMS over conventional CMS (c-CMS) has not been established. Therefore, we conducted this retrospective study to evaluate the long-term efficacy and safety of DMS as a second stent in comparison with c-CMS. Methods: We investigated consecutive patients with distal MBO due to unresectable pancreatic cancer who underwent reintervention after dysfunction of initial biliary CMS at our institution. We compared causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and reintervention rates of DMS and c-CMS in this stenting. Results: A total of 76 patients were included (DMS 41 and c-CMS 35). While overall RBO rates were similar between the two groups (46% vs. 63%, p = 0.172), RBO due to non-occlusion cholangitis tended to be less frequent in the DMS group than in the c-CMS group (2% vs. 14%, p = 0.089). Median TRBO was significantly longer in the DMS group (286 days vs. 112 days, p = 0.029). DMS was identified as the only significant risk factor for TRBO (hazard ratio, 0.52; p = 0.044). Overall AE rates were significantly lower in the DMS group (2% vs. 23%, p = 0.010), with non-occlusion cholangitis being the most common AE in the c-CMS group. Endoscopic reintervention was successfully performed in all patients in both groups, despite failed stent removal in 15% of patients in DMS group. Conclusions: DMS was associated with a significantly longer TRBO and lower rate of AEs compared with c-CMS in reinterventions after initial CMS dysfunction. DMS may be preferable to c-CMS as a second stent after biliary CMS dysfunction. [ABSTRACT FROM AUTHOR]

Background/Aims Covered metal stent (CMS) for biliary obstruction is expected to have longer patency and lower in growth rate compared to uncovered metal stent (UCMS). However, high migration rate is major concern of CMS. This study aimed to assess clinical outcomes of simultaneous side-by-side insertion of both CMS and PS. Methods CMS with PS was applied into 41 patients from 2017 and patients' medical records were reviewed retrospectively. Technical success was defined as successful placement of stents across a stricture. Functional success was defined as over 50% improvement or normalization in bilirubin within 2 weeks. Results The technical and functional success rate both were 100%. 23 patients (56%) underwent both stents insertion as an initial treatment. Endoscopic sphincterotomy was initially performed for 24 (59%) patients. Median time to recurrent biliary obstruction was 366 days (95% CI 241-490). Six patients (15%) were confirmed as re-stenosis. These all were caused by tumor ingrowth (n=6) and no patients experienced stent migration nor clogging. All patients confirmed as re-stenosis took revision ERCP successfully. Seven patients (17%) died and no procedure-related death was found. Median follow-up was 144 days (15 to 459 days) and median overall survival was not reached due to insufficient follow- up period. Five procedure-related complications were observed, three for liver abscesses, one for acute cholecystitis and one for post-EST bleeding. Liver abscesses occurred at 12, 32 and 70 days after stent placement, respectively. The initial stenosis sites of three liver abscess patients above were confirmed equally as proximal (n=1), hilar (n=1) and distal (n=1) obstruction. No acute cholangitis nor post-ERCP pancreatitis was observed. Conclusions Side-by-side insertion of both CMS and PS showed good success rate, long patency and few stent-related complications. Most notably, no stent migration was observed. This result may provide clinical background for further comparative study with UCMS. [ABSTRACT FROM AUTHOR]