Enigma of Esophageal-Respiratory Fistula in Advanced Esophageal Cancer

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Bhardwaj Sheeba; Paul Diptajit; Kaushal Vivek

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Journal Paper

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Journal: Basic & Clinical Cancer Research Year:2021 | Volume:13 | Issue:4 Page(s): 239-244

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Information Journal Paper

Title

Enigma of Esophageal-Respiratory Fistula in Advanced Esophageal Cancer

Author(s)

Bhardwaj Sheeba | Paul Diptajit | Kaushal Vivek | Issue Writer Certificate

Keywords

Esophageal-pleural/bronchial fistula

Esophageal cancer

Abstract

Background: The incidence of malignant esophageal-respiratory fistulas in Esophageal cancer patients is not so frequent. The fistula development in Esophageal cancer may be due to advanced disease or a radiotherapy-related complication. Rarely, a pulmonary abscess may develop, which is the most dreadful complication resulting in dismal outcomes. Here, we reported 2-cases of esophageal-respiratory fistula,one with esophageal bronchial fistula and the other with esophageal pleural fistula. Case reports: A 46-year-aged man presented with complaints of difficulty in swallowing for 4 months. CECT chest showed an esophageal growth of 8. 5 cm in the lower esophagus. The patient received palliative radiotherapy followed by palliative chemotherapy and showed some improvement in dysphagia. Nine months after the start of treatment, the patient’, s dysphagia began to worsen, and he was put on oral metronomic chemotherapy. After 1-year of metronomic chemotherapy, the patient developed cough and chest pain and was diagnosed with an esophageal-pleural fistula with chest wall collection and pleural effusion. The patient was managed conservatively and later lost to follow-up. Another 65-year-old patient presented with dysphagia for 3-months. CECT chest showed an esophageal growth of 5. 5 cm in the middle esophagus. The patient received palliative radiotherapy, after which the dysphagia improved. In 3rd month of follow up patient’, s dysphagia worsened,barium swallow showed esophageal-bronchial fistula. The patient was managed symptomatically and later lost to follow-up. Conclusions: Fistula formation and subsequent abscess results in a poor prognosis. With advancing disease and compromised general condition of the patient, palliation of symptoms is a significant challenge. Treatment becomes difficult due to the rare occurrence of fistulas and the non-standardization of the treatment protocol. Invasive treatment includes esophageal-pulmonary resection, endoscopic placement of self-expandable covered stents, drainage of empyema and obliteration of empyema cavity, esophageal diversion, and non-invasive treatment includes best supportive care. However, even with appropriate treatment, the outcome is dismal.

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APA: Copy

Bhardwaj, Sheeba, Paul, Diptajit, & Kaushal, Vivek. (2021). Enigma of Esophageal-Respiratory Fistula in Advanced Esophageal Cancer. BASIC & CLINICAL CANCER RESEARCH, 13(4), 239-244. SID. https://sid.ir/paper/1100898/en

Vancouver: Copy

Bhardwaj Sheeba, Paul Diptajit, Kaushal Vivek. Enigma of Esophageal-Respiratory Fistula in Advanced Esophageal Cancer. BASIC & CLINICAL CANCER RESEARCH[Internet]. 2021;13(4):239-244. Available from: https://sid.ir/paper/1100898/en

IEEE: Copy

Sheeba Bhardwaj, Diptajit Paul, and Vivek Kaushal, “Enigma of Esophageal-Respiratory Fistula in Advanced Esophageal Cancer,” BASIC & CLINICAL CANCER RESEARCH, vol. 13, no. 4, pp. 239–244, 2021, [Online]. Available: https://sid.ir/paper/1100898/en

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