What are the treatment options for malignant tracheoesophageal fistula (TEF)?

Updated: Nov 07, 2018
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Answer

Treatment of malignant TEFs must be individualized, and the treatment should be instituted promptly. The therapy is generally palliative. Palliation consists of relief of obstruction and diversion of contamination from the respiratory tract. The procedures offered include endoprosthesis (covered self-expandable metal stent [SEMS]), esophageal exclusion or bypass, resection, or direct closure. Supportive therapy is recommended for patients who present late in the course of the fistula and already have pulmonary sepsis. The supportive measures include nasogastric drainage, tracheostomy, gastrostomy, and intravenous hydration and antibiotics.

Burt et al reported that bypass therapy and radiation therapy were the only treatments that significantly prolonged survival compared to supportive care. [6] With radiation therapy, TEFs initially heal but usually recur, leading to respiratory tract contamination. Esophageal bypass with gastric, colonic, or jejunal interposition would have significantly improved survival rates but has a high risk of immediate mortality.


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