Esophageal - Respiratory Fistula in Advanced Esophageal Cancer: Report of Two Cases

The incidence of malignant esophageal-respiratory fistulas in esophageal cancer patients is not so frequent. Development of fistula in esophageal cancer may be due to advanced disease or may be a radiotherapy related complication. Rarely, pulmonary abscess may develop and it is the most dreadful complication resulting in dismal outcomes. Here, we reported 2-cases of esophageal-respiratory fistula; one with esophageal bronchial fistula and other with esophageal pleural fistula.

Case reports: 

A 46-year-aged man presented with complaints of difficulty in swallowing from 4-months. CECT chest showed an esophageal growth of 8.5 cm in lower esophagus. Patient received palliative radiotherapy followed by palliative chemotherapy and showed some improvement in dysphagia. After 9–months from start of treatment, patient’s dysphagia began to worsen and he was put on oral metronomic chemotherapy. After 1-year of metronomic chemotherapy, patient developed cough and chest pain and was diagnosed as a case of esophageal-pleural fistula with chest wall collection and pleural effusion. Patient was managed conservatively and later lost to follow up. Another, 65-year-old patient presented with dysphagia from 3-months. CECT chest showed an esophageal growth of 5.5 cm in middle esophagus. Patient received palliative radiotherapy after which the dysphagia improved. On 3rd month of follow up patient’s dysphagia worsened; barium swallow showed esophageal-bronchial fistula. Patient was managed symptomatically and later lost to follow up.

Fistula formation and subsequent abscess results in poor prognosis. With advancing disease and compromised general condition of the patient, palliation of symptoms is an important challenge. Treatment becomes difficult due to rare occurrence of fistulas and non-standardization of treatment protocol. Invasive treatment includes esophageal-pulmonary resection, endoscopic placement of self-expandable covered stents, drainage of empyema and obliteration of empyema cavity, esophageal diversion, and non-invasive treatment includes best supportive care. However, even with appropriate treatment, outcome is dismal.