1724 Acquired Broncho-Esophageal Fistula After 10 Years of Esophageal Stent Placement

INTRODUCTION: Acquired benign Broncho-esophageal fistulas (BEF) are uncommon and develops as a complication of inflammatory processes, malignant neoplasm and traumas of the chest but it has been rarely reported with esophageal or tracheal stents. We are reporting a case of Lt BEF after 10 years of esophageal stent placement for recurrent benign esophageal stricture. CASE DESCRIPTION/METHODS: A 52 years-old-female with history of HIV-1 infection was admitted with dysphagia to solid food. Her condition started 10 years ago after she presented with progressive odynophagia and dysphagia to solids and liquids. EGD at that time showed giant aphthous esophageal ulcer, 25 to 34 cm from the incisors, involving entire esophageal circumference. Biopsy showed ulcerated squamous mucosa with diffuse acute and chronic inflammation, negative stains for acid fast bacilli, fungal infection, CMV and HSV. She was treated with pantoprazole, hydrocortisone and thalidomide without improvement of her symptoms. Repeated EGD showed formation of benign esophageal stricture with negative repeated biopsy results. Over 6 months, she underwent multiple balloon dilatation of the stricture until 16 to 20 mm × 120 mm in length, Polyflex stent was placed with improvement of her symptoms She was lost for follow up before presenting again with progressive dysphagia to solids of 3 months duration associated with progressive weight loss. Esophagogram showed stable position of the stent in the mid esophagus with stable dilated proximal esophagus and no esophageal stricture. Due to concern of stent malfunction, the stent was removed but the patient continued to have dysphagia. Repeated esophagogram four days later, showed contrast media in the Left main bronchus tracking to the left lower lung lobe. Bronchoscopy and upper endoscopy showed chronic acquired Broncho-esophageal fistula extending from the lateral edge of membranous left main bronchus to the esophagus, 25 cm from incisors. PEG tube was placed for nutrition and she is planned for fistula repair in two weeks. DISCUSSION: BEF is a serious condition and treatment is mandatory to avoid continuous aspiration, chronic sepsis, and pulmonary failure, mainly in immunocompromised patients. There are no studies on the incidence of such fistulas after esophageal stent placements. On the other hand, some studies favored tracheal or esophageal stents as a corrective measure, although neither are free from complications, and they are palliative measures, making surgical repair the best option.