Giant Tracheoesophageal Fistula Treated with a Covered Airway Stent: A Case Report

Abstract

This case report describes the management of a large tracheoesophageal fistula in a 63-year-old male patient with advanced upper oesophageal cancer. Following chemoradiotherapy (cisplatin, 5-fluorouracil, and 60 Gy radiation), disease progression led to the formation of a 27 mm fistula due to direct tumour infiltration, causing recurrent aspiration pneumonia. Bronchoscopy revealed that the fistula extended from 23 mm to 50 mm below the vocal cords with surrounding ulceration. Oesophageal stent placement was deemed unfeasible due to severe mucosal fragility and cancerous infiltration. After multidisciplinary consultation, a bronchial approach was selected. A 20 mm × 80 mm covered self-expanding metallic stent was successfully placed to fully cover the fistula. Post-procedure, the patient experienced significant improvement in sputum production, dyspnoea, and quality of life, with complete resolution of recurrent aspiration pneumonia until transfer to hospice care. Importantly, airway stenting primarily contributed to symptom relief and quality-of-life improvement rather than prolongation of survival. Tracheoesophageal fistulas occur in 5%-15% of patients with oesophageal cancer, with higher rates following chemoradiotherapy. Despite poor prognosis (median survival 3-4 months), airway stenting represents a valuable palliative option for improving quality of life when oesophageal approaches are contraindicated.