Management of esophagorespiratory fistula due to carcinoma esophagus with palliative intubation, gastric decompression and transgastric feeding jejunostomy.

ABSTRACT

BACKGROUND: Carcinoma esophagus with esophagorespiratory fistula has a poor prognosis. Water and food intake suffers and pulmonary contamination leads to lung infection. Treatment is essentially palliative. METHODS: Thirty-five patients with esophagorespiratory fistula secondary to esophageal carcinoma were treated with palliative esophageal intubation, gastrostomy and transgastric feeding jejunostomy. RESULTS: Esophageal prosthesis could be implanted in 34 patients. One patient died in the postoperative period. Twenty-nine patients were able to swallow saliva without leakage into the lungs. Only four patients were able to take full diet orally for any significant length of time. An 18-G needle inserted in the gastrostomy Malecot's catheter provided outlet for air in the stomach and prevented rise in intragastric pressure and gastroesophageal reflux. Transgastric feeding jejunostomy functioned satisfactory. Twenty patients were followed up; the average survival was 58 days (range 9-337 days). CONCLUSION: Esophageal intubation, gastrostomy and transgastric feeding jejunostomy provide satisfactory palliation for patients with esophagorespiratory fistula secondary to carcinoma esophagus.