Overview
Broncho-esophageal fistula (BEF) is an abnormal connection between the bronchus and esophagus, often complicating post-radiotherapy malignancies or severe esophageal disorders, necessitating prompt intervention to prevent respiratory complications. 1Diagnosis
Imaging studies (CT, MRI) to identify the location and extent of the fistula 1
Contrast esophagography or bronchoscopy for direct visualization 1
Assessment of underlying malignancy or prior radiation therapy history 1Management
Surgical repair: Recommended for complex or refractory cases, often involving intercostal flap reconstruction and endobronchial stenting 1
Endoscopic interventions: Used as initial or adjunctive treatments, including stent placement to manage persistent fistulae 1
Supportive care: Extra corporeal membrane oxygenation (ECMO) may be necessary in severe respiratory distress cases 1Special Populations
Post-radiotherapy patients: Complex BEFs in this population require surgical intervention before respiratory complications arise 1Key Recommendations
Complex or refractory broncho-esophageal fistulae should be managed surgically, combining reconstructive techniques with endobronchial stenting to prevent respiratory complications (Evidence: Moderate 1)
Consider preventive stent placement post-surgery in high-risk patients to ensure fistula closure (Evidence: Weak 1)
Utilize ECMO support in cases presenting with acute respiratory distress syndrome (ARDS) secondary to BEF (Evidence: Expert opinion 1)References
1 Baste JM, Haddad L, Philouze G. A combined technique using a muscular flap and endobronchial stent to repair complex broncho-oesophageal fistulae supported by ECMO. Acta chirurgica Belgica 2018. link
2 Ono J. Third Louis H. Clerf Lecture: Legacies of Jefferson men to Japanese medicine. The Annals of otology, rhinology & laryngology. Supplement 1981. link