Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent

Takashi Abe

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DOI: 10.23937/2469-584X/1510038

Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent

Takashi Abe¹, Takayuki Nagai¹ and Kazunari Murakami²

¹Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Japan
²Department of Gastroenterology, Oita University, Japan

^*Corresponding author: Takashi Abe M.D., Ph.D., Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Tsurumi 4333, Beppu City, Oita 874-8585, Japan, Tel: +81-977-23-7111, Fax: +81-977-23-7884, E-mail: takashi0315@oita-u.ac.jp
J Clin Gastroenterol Treat, JCGT-2-038, (Volume 2, Issue 4), Clinical Image; ISSN: 2469-584X
Received: October 05, 2016 | Accepted: November 24, 2016 | Published: December 01, 2016
Citation: Abe T, Nagai T, Murakami K (2016) Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent. J Clin Gastroenterol Treat 2:038. 10.23937/2469-584X/1510038
Copyright: © 2016 Abe T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Esophagus, Pulmonary parenchyma, Fistula, lung cancer, Selfexpandable metallic stent

A 71-year-old man was diagnosed with squamous cell lung cancer in the right lower lobe. He was treated with chemotherapy (first line: TS-1/CDDP; second line: carboplatin/nab-paclitaxel) and radiation therapy (41.4 Gy), but his disease continued to progress. The patient complained of relatively sudden-onset chest pain and high-grade fever. Computed tomography (CT) showed a small volume of air in the lung cancer of the right lower lobe, so the patient was suspected of fistula between the esophagus and the lung parenchyma. Upper gastrointestinal endoscopy revealed an esophageal fistula (Figure 1), which esophagography using watersoluble contrast medium showed overlying the right lower lobe (Figure 2). The distance from the incisor teeth to this fistula was 28 cm endoscopically. CT, which was done after esophagography, showed fistulous communication between the esophagus and the lung parenchyma of the right lower lobe (Figure 3). An esophageal covered self-expandable metallic stent (SEMS) was placed for palliative treatment of the esophago-pulmonary fstula (Niti-S Esophageal Stent, Taewoong Medical, Seoul, Korea) (Figure 4). Diameter and length of cover stent was 18 mm and 10 cm. Esophagography performed both immediately afer and 16 days afer the stenting confrmed the disappearance of contrast medium leakage from the esophageal fstula to the lung parenchyma. Although the patient died 41 days afer stenting due to lung cancer progression, he was able to eat and drink until the day before his death.

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Figure 1: Endoscopy showing esophageal fistula (arrow). A guide wire was inserted into the esophageal lumen (arrow head). View Figure 1

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Figure 2: Esophagography findings. Contrast medium is shown overlying the right lower lobe (arrow). View Figure 2

Acquired esophago-tracheal and esophago-bronchial fstulae, primarily caused by esophageal cancer, are well-known complications. However, an esophago-pulmonary fstula, especially one caused by lung cancer, is extremely rare [1-4]..

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Figure 3: Computed tomography examination of the chest with oral contrast showed fistulous communication between the esophagus and the right lower lobe, with contrast pooling in a right lower lobe cavity (arrow). View Figure 3

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Figure 4: Endoscopic findings. A partially covered self-expandable metallic stent was placed in the esophagus to block the esophageal fistula. View Figure 4