Dual Stenting of a Bronchoesophageal Fistula: A Case Report of Bronchial Stenting after Failed Esophageal Stent Placement

Dysphagia and respiratory sequela are a common phenomenon when treating patients with a tracheoesophageal fistula. We report the case of a 78-year-old man who presented for bronchial stent placement of a recurrent bronchoesophageal fistula secondary to advanced esophageal carcinoma. The patient previously had an esophageal stent placed, which failed after 2 weeks as a result of stent migration and was subsequently removed. A Microvasive Ultraflex (Microvasive, Watertown, MA) metal bronchial stent was placed in conjunction with another esophageal stent. The combination of the 2 stents likely helped anchor the esophageal stent, improved our patient's quality of life, and avoided the problem of stent migration. In correctly selected patients, single esophageal stent therapy in those having esophageal malignancy-associated pulmonary fistula has previously been the standard of care. We postulate that dual stenting can offer a significant benefit in terms of reduced migration rates and improved seal of the fistula. By placing a bronchial stent first, the subsequent esophageal stent did not undergo the prior complication of migration. As a result of the contributory pressure from the 2 opposing stents, the fistula was sealed.