Stent-associated esophagorespiratory fistulas: Incidence and risk factors

Benjamin L. Bick, Louis M. Wong Kee Song, Navtej S. Buttar, Todd H. Baron, Francis C. Nichols, Fabien Maldonado, David A. Katzka, Felicity T. Enders, Mark D. Topazian

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Background: Esophageal self-expandable stents (SESs) effectively treat strictures and leaks but may be complicated by a stent-associated esophagorespiratory fistula (SERF). Little is known about SERFs. Objective: To determine the incidence, morbidity, mortality, and risk factors for SERF. Design: Retrospective case-control study. Setting: Single referral center. Patients: All adults undergoing esophageal SES placement during a 10-year period. Intervention: Stent placement. Main Outcome Measurements: Occurrence of SERF, morbidity, and mortality. Results: A total of 16 of 397 (4.0%) patients developed SERF at a median of 5 months after stent placement (range 0.4-53 months) including 6 of 94 (6%), 10 of 71 (14%), and 0 of 232 (0%) of those with lesions in the proximal, middle, and distal esophagus, respectively (overall P <.001). SERF occurred in 10% of those with proximal and mid-esophageal lesions, including 14% with benign strictures, 9% with malignant strictures, and none with other indications for SES placement (P =.27). The risk was highest (18%) in patients with benign anastomotic strictures. Risk factors for development of SERF included a higher Charlson comorbidity index score (odds ratio [OR] 1.47 for every 1-point increase; P =.04) and history of radiation therapy (OR 9.41; P =.03). Morbidity associated with SERF included need for lifelong feeding tubes in 11 of 22 (50%) and/or tracheostomy or mechanical ventilation in 5 of 22 (23%). Median survival after diagnosis was 4.5 months (range 0.35-67), and 7 patients survived less than 30 days. Limitations: Retrospective design, limited statistical power. Conclusion: SERF is a morbid complication of SES placement for strictures of the proximal and mid-esophagus. The dominant risk factors for development of SERF are prior radiation therapy and comorbidity score.

Original languageEnglish (US)
Pages (from-to)181-189
Number of pages9
JournalGastrointestinal endoscopy
Issue number2
StatePublished - Feb 2013

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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