Abstract Rationale Tracheo-esophageal fistula (TEF) is a rare but serious complication of advanced malignancy or prior airway and esophageal interventions. It leads to aspiration, respiratory distress, and poor quality of life. Stent placement remains a cornerstone of palliative management by isolating the airway and restoring ventilation and swallowing. Methods This retrospective observational study was conducted at a single tertiary care center between January 2012 and November 2025. Data were collected from patient records using a standardized case record form. Variables analyzed included demographics, etiology, fistula location, oncologic therapy, presence of aspiration pneumonia, stenting details, and clinical outcomes. Descriptive statistics were used for analysis. Results A total of 55 patients were analyzed (33 males, 22 females) with a mean age of 53.6 ± 14.9 years (range, 19-87). The majority were malignant, most commonly esophageal carcinoma. Benign etiologies included post-intubation or post-tracheostomy tracheal stenosis, tuberculosis, and congenital fistulae. Most fistulae involved the middle and lower thirds, followed by the left main bronchus and upper third. Aspiration pneumonia was present in 25 patients. A tracheal stent was placed in all cases for airway protection and palliation. Among 19 dual-stented patients, two underwent same-day tracheal and esophageal stenting, while 17 had prior esophageal stents (for esophageal carcinoma or post-radiation stricture) that later required tracheal stenting after fistula development. Of 36 patients receiving tracheal stents alone, 33 were treated for existing TEF and three developed TEF following tracheal stenting for airway compression or stenosis. Both self-expanding metallic and silicone stents were used. Immediate outcomes included complete fistula coverage in all patients. Approximately 70% resumed oral intake, while others continued nasogastric or percutaneous endoscopic gastrostomy feeds due to esophageal compression. Intermediate to long-term outcomes demonstrated no significant stent migration. Increased airway secretions requiring surveillance bronchoscopy occurred in 80%, and mild granulation tissue in 25% did not necessitate intervention. Mortality occurred in 48 patients—four from aspiration pneumonia (median seven days post-stenting) and 44 from malignancy progression. Conclusion Tracheal stenting was the primary modality for airway protection and palliation in TEF. It provided reliable fistula coverage and allowed oral feeding in most patients, with minimal migration or major complications. In malignant TEF, tracheal stenting may offer superior palliation compared with esophageal stenting, particularly as a salvage or primary intervention when surgery is not feasible. Larger prospective studies are warranted to assess long-term outcomes and refine selection criteria for airway stenting in this complex condition. This abstract is funded by: None
Magar et al. (Fri,) studied this question.