Abstract Tracheoesophageal fistulas (TEF) are a serious complication that can occur in patients with advanced esophageal cancer. These fistulas typically result from direct tumor invasion into the airway or as a consequence of radiotherapy. Communication between the trachea and esophagus leads to recurrent aspiration, respiratory compromise, and malnutrition. Management involves sealing the fistula through tracheal stenting to restore airway patency and prevent aspiration. We report a case of a complex TEF that was successfully managed with a customized silicone Y-stent. A 74-year-old man with a past medical history of esophageal squamous cell carcinoma status post radiation and chemotherapy presented to an outside hospital with failure to thrive. He was found to have a TEF, for which a tracheal stent was placed. The stent subsequently migrated distally, leaving approximately 2 mm of his fistula uncovered. Thus, a second stent was placed proximally overlapping the original. However, both stents migrated distally to the main carina, partially obstructing both mainstem bronchi. His course was further complicated by acute hypoxemic respiratory failure secondary to aspiration pneumonia requiring intubation. He was transferred to our hospital for complex airway management. Both stents were removed via rigid bronchoscopy. Due to critical illness and septic shock, a tracheostomy was performed with placement of an extended-length tracheostomy tube to bypass the fistula. He followed up with our interventional pulmonology team after recovering from his critical illness. Given his recurrent stent migration and the need to phonate, a customized silicone Y-stent was created and placed successfully without complication. His tracheostomy tube was positioned within the tracheal lumen of the Y-stent for mucociliary clearance. Interval bronchoscopy confirmed appropriate stent positioning without evidence of migration. The patient demonstrated marked improvement in his symptoms and functional status following stent placement. This case highlights the impact of a customized silicone Y-stent used for successful management of a complex TEF. The tailored Y-stent design was able to provide effective fistula occlusion and restored airway integrity after multiple failed attempts with standard stents. Customized Y-stents can provide an effective and durable solution for TEFs, particularly when these fistulas are located near the carina, involving the main bronchi, or are very high within the trachea. Furthermore, the custom fit decreases the risk of further stent migration. Clinicians should strongly consider custom-made Y-stents for management of complex TEF cases when conventional stenting attempts fail. This abstract is funded by: None
Luthcke et al. (Fri,) studied this question.