Airway stenting for malignant aerodigestive fistulae: A critical review of the literature and treatment recommendations

The development of trachea- or broncho-esophageal fistulae is a devastating thoracic malignancy complication leading to increased morbidity and mortality due to pneumonia, sepsis, and malnutrition. Due to this high morbidity and mortality, attempts to close or cover the fistula are often undertaken. Multiple modalities have been evaluated and reported to treat malignant aerodigestive fistulae (MAF), although no single approach has become the standard of care. The American College of Chest Physicians recommends palliative stenting for MAF, but this approach may not be effective depending on size, configuration, and position of the fistula. This manuscript will critically evaluate the role of single airway stenting or double airway and esophageal stenting in MAF palliation. We will recommend an approach to consider with regard to the management of these fistulae.