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Thorac Cardiovasc Surg 2024; 72(02): 156-161
DOI: 10.1055/a-2122-7149
Original Thoracic

The Two-Tube Method for Treating Thoracogastric Airway Fistula

Chenchen Zhang
1   Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
,
Xiaobing Li
1   Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
,
Zhanfeng He
2   Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China
,
Shuai Wang
1   Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
,
Meipan Yin
1   Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
,
Yaozhen Ma
1   Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
,
Gang Wu
1   Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
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Abstract

Background Thoracogastric airway fistula (TGAF) is a fatal complication after esophagectomy. Without active treatment, patients may die of intractable pneumonia, sepsis, massive hemoptysis, or respiratory failure. We determined the clinical value of the two-tube method that involves the precise interventional placement of the nasojejunal tube (NJT) and nasogastric tube (NGT) for TGAF.

Methods Clinical data of patients with TGAF who had undergone fluoroscopic interventional placement of NJT and NGT were analyzed retrospectively. The paired t-test was used to compare the index values before and after treatment. Statistical significance was set at p < 0.05.

Results In total, 212 patients (177 male and 35 female; mean age, 61.3 ± 7.9 years [47–73]) with TGAF who had undergone the two-tube method were included. Posttreatment chest spiral computed tomography and inflammatory indicators showed significantly improved pulmonary inflammation compared with that before treatment. The patients' general condition remained stable. Of 212 patients, 12 (5.7%) underwent surgical repair, 108 (50.9%) received placement of airway stents, and 92 (43.4%) cases only continued treatment with the two-tube method owing to patients' conditions. In total, 47.8% (44/92) patients died of secondary pulmonary infection, bleeding, and primary tumor progression, whereas 52.2% (48/92) patients survived with both tubes.

Conclusion The two-tube method, which involves the precise interventional placement of the NJT and NGT, is simple, safe, and effective for treating TGAF. This method is a bridge for successive treatments or a treatment itself for patients who are unsuitable for surgical repair or stent placement.

Keywords

airway (includes related subject matter) - esophageal surgery - infection - surgery - complications


Publication History

Received: 14 March 2023

Accepted: 29 June 2023

Accepted Manuscript online:
04 July 2023

Article published online:
03 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Sahebazamani M, Rubio E, Boyd M. Airway gastric fistula after esophagectomy for esophageal cancer. Ann Thorac Surg 2012; 93 (03) 988-990
    Google Scholar
  • 2 Wang C, Li C, Yang X. et al. The classification and treatment strategies of post-esophagectomy airway-gastric fistula. J Thorac Dis 2020; 12 (07) 3602-3610
    Google Scholar
  • 3 Miyata K, Fukaya M, Nagino M. Repair of gastro-tracheobronchial fistula after esophagectomy for esophageal cancer using intercostal muscle and latissimus dorsi muscle flaps: a case report. Surg Case Rep 2020; 6 (01) 172
    Google Scholar
  • 4 Balakrishnan A, Tapias L, Wright CD. et al. Surgical management of post-esophagectomy tracheo-bronchial-esophageal fistula. Ann Thorac Surg 2018; 106 (06) 1640-1646
    Google Scholar
  • 5 Wang H, Tao M, Zhang N. et al. Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing. Ther Adv Respir Dis 2019; 13: 1753466619871523
    Google Scholar
  • 6 Bartels HE, Stein HJ, Siewert JR. Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome. Br J Surg 1998; 85 (03) 403-406
    Google Scholar
  • 7 Han X, Li L, Zhao Y. et al. Individualized airway-covered stent implantation therapy for thoracogastric airway fistula after esophagectomy. Surg Endosc 2017; 31 (04) 1713-1718
    Google Scholar
  • 8 Boyd M, Rubio E. The utility of stenting in the treatment of airway gastric fistula after esophagectomy for esophageal cancer. J Bronchology Interv Pulmonol 2012; 19 (03) 232-236
    Google Scholar
  • 9 Fischer A, Höppner J, Utzolino S, Richter-Schrag HJ. Over-the-scope clip (OTSC) closure of a gastrobronchial fistula after esophagectomy. Endoscopy 2014; 46 (Suppl 1 UCTN): E638-E639
    Google Scholar
  • 10 Inage T, Nakajima T, Fujiwara T. et al. Bronchial embolization with an endobronchial Watanabe spigot for broncho-gastric tube fistula. Respiration 2017; 94 (04) 375-379
    Google Scholar
  • 11 Buitrago DH, Pinto D, Berkowitz SJ, Laham RJ, Hecht JL, Kent MS. Fatal hemoptysis after closure of gastrobronchial fistula using an Amplatzer vascular device. Ann Thorac Surg 2018; 105 (02) e71-e73
    Google Scholar
  • 12 Li TF, Duan XH, Han XW. et al. Application of combined-type Y-shaped covered metallic stents for the treatment of gastrotracheal fistulas and gastrobronchial fistulas. J Thorac Cardiovasc Surg 2016; 152 (02) 557-563
    Google Scholar
  • 13 Shi H, Wang WP, Gao Q, Chen LQ. Single-stage surgical repair of airway gastric fistula after esophagectomy. J Cardiothorac Surg 2014; 9: 30
    Google Scholar
  • 14 Bockbrader M, Kim E. Role of intensity-modulated radiation therapy in gastrointestinal cancer. Expert Rev Anticancer Ther 2009; 9 (05) 637-647
    Google Scholar
  • 15 Liu Q, Cai XW, Fu XL, Chen JC, Xiang JQ. Tolerance and dose-volume relationship of intrathoracic stomach irradiation after esophagectomy for patients with thoracic esophageal squamous cell carcinoma. Oncotarget 2015; 6 (31) 32220-32227
    Google Scholar
  • 16 Reames BN, Lin J. Repair of a complex bronchogastric fistula after esophagectomy with biologic mesh. Ann Thorac Surg 2013; 95 (03) 1096-1097
    Google Scholar
  • 17 Wang SY, Yuan WC, Wu EB. Airway management during left-sided gastrobronchial fistula repair after esophagectomy for esophageal carcinoma: a case report. Medicine (Baltimore) 2021; 100 (35) e27133
    Google Scholar
  • 18 Li Y, Wang Y, Chen J. et al. Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: a systematic literature review. J Int Med Res 2020; 48 (05) 300060520926025
    Google Scholar
  • 19 Jha PK, Deiraniya AK, Keeling-Roberts CS, Das SR. Gastrobronchial fistula–a recent series. Interact Cardiovasc Thorac Surg 2003; 2 (01) 6-8
    Google Scholar
  • 20 Fernando HC, Sherwood JT, Krimsky W. Endoscopic therapies and stents for benign airway disorders: where are we, and where are we heading?. Ann Thorac Surg 2010; 89 (06) S2183-S2187
    Google Scholar
  • 21 Kim JH, Shin JH, Song H-Y, Choi CM, Shim TS. Esophagorespiratory fistula without stricture: palliative treatment with a barbed covered metallic stent in the central airway. J Vasc Interv Radiol 2011; 22 (01) 84-88
    Google Scholar
  • 22 Chung YJ, Kim JH, Kim DJ, Kim JJ. Successful management of a tracheo-gastric conduit fistula after a three-field esophagectomy with combined sternocleidomastoid muscle rotation flap and Histoacryl injection treatment. J Gastric Cancer 2020; 20 (04) 454-460
    Google Scholar
  • 23 Zhang H, Wang Y, Sun S. et al. Early enteral nutrition versus delayed enteral nutrition in patients with gastrointestinal bleeding: a PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98 (11) e14864
    Google Scholar
  • 24 Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients 2013; 5 (02) 608-623
    Google Scholar
  • 25 Jankowski M, Las-Jankowska M, Sousak M, Zegarski W. Contemporary enteral and parenteral nutrition before surgery for gastrointestinal cancers: a literature review. World J Surg Oncol 2018; 16 (01) 94
    Google Scholar
  • 26 Tapia J, Murguia R, Garcia G, de los Monteros PE, Oñate E. Jejunostomy: techniques, indications, and complications. World J Surg 1999; 23 (06) 596-602
    Google Scholar