Endoscopic management of malignant tracheoesophageal fistulas

Tracheoesophageal fistula (TEF) is a dreaded complication of esophageal cancer or cancer metastatic to the mediastinum. The recently introduced self- expanding metal stents (SEMS) are a safe and effective palliative option for patients with a malignant TEF, permitting them to be discharged from the hospital and to resume an oral diet. The endoscopic technique of inserting SEMS involves placing a guidewire into the esophagus, adjacent to the tumor. The stent, compressed within its delivery device, is advanced over the guidewire to a premarked position, released, and allowed to expand. SEMS can be placed successfully in more than 95% of eligible patients and can effectively close a TEF in approximately 90%.