Combined oesophageal and airway stenting for malignant oesophageal strictures: a retrospective cohort study and development of a novel algorithm

Objective Malignant oesophageal strictures can cause airway compromise and fistula formation. Combined oesophageal and airway stenting is a potential treatment, yet no guidelines exist. This study aims to describe the outcomes of same-session oesophageal and airway endoscopic stenting for malignant strictures and propose an algorithm for intervention. Method A retrospective cohort study on patients undergoing same-session gastrointestinal (GI) and respiratory endoscopy at University College London Hospital between 2019 and 2023. Data collected included malignancy type, degree of luminal narrowing (%), completed interventions, complications and mortality. The primary objective was to describe interventions performed during same-session procedures, with a focus on developing a decision-based algorithm. Results 26 patients were identified with a mean age of 63 years. Primary cancer type was oesophageal (81%) or lung (19%). The most common referral indication was dysphagia (42%), although radiological signs of airway compromise were frequently seen on imaging (65%). Stent insertion included oesophageal only (35%), airway only (19%) and dual (27%). After oesophageal stenting, repeat bronchoscopy showed increased airway stenosis in four patients (25%). There was only one intraoperative complication, an oesophageal perforation. New tracheo-oesophageal fistula was the most common post-intervention complication (15%). Median time from malignancy diagnosis to death was 7.9 weeks. Conclusion Malignant oesophageal strictures with airway involvement are a challenging condition to treat. Given the complexity of cases, joint upper GI and respiratory multidisciplinary discussion is suggested to plan any intervention including same-session endoscopy. To our knowledge, we present the first algorithm for endoscopic stenting in patients with malignant oesophageal stricture and airway involvement. Decision-making should be framed by patient-centred goals, as this group demonstrated poor prognosis.