Application of combined-type Y-shaped covered metallic stents for the treatment of gastrotracheal fistulas and gastrobronchial fistulas.

Objective: To determine the safety and feasibility of combined-type integrated Y-shaped self-expanding covered metallic stents to treat gastrotracheal fistulas (GTFs) and gastrobronchial fistulas (GBFs).
Methods: We retrospectively reviewed the data of 10 patients with postoperative GTFs or GBFs. Depending on the size and location of the fistula and the airway diameter, we custom-designed 2 or 3 stents for each patient. The combined-type stents consisted of a large and a small Y-shaped stent. Under fluoroscopic guidance, the small stent was inserted into the distal part of the involved airway. Then, the large stent was placed at the trachea and carina. The large stent partly overlapped the main body of the small stent.
Results: All stents were successfully inserted at the first attempt. Esophageal and airway radiography showed no contrast agent leakage, indicating that the fistula was fully sealed. After the procedure, the patients could resume eating without coughing, and their quality of life improved. Each patient was fully followed up. Six patients died at 3.2 to 8 months of tumors (4 patients), hemoptysis (1 patient), or pulmonary infection (1 patient). In 1 patient, the carinal fistula enlarged 4 months after stenting, and another small Y-shaped stent was inserted to seal the fistula. This patient and the remaining 3 patients are still alive.
Conclusions: Deployment of the combined-type Y-shaped integrated self-expanding covered metallic stent proved to be an effective, safe, and minimally invasive procedure for complex GTFs and GBFs. Our patients tolerated the stents well and had good palliation of their symptoms.
(Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)