C78-05 Bronchoesophageal Fistula With Respiratory Decompensation: Pulmonary Management and Palliative Stenting

Abstract Bronchoesophageal fistula (BEF) is a rare but life-threatening condition often associated with advanced esophageal cancer (5-10% of cases) that can lead to recurrent pneumonia, respiratory failure, and significant morbidity due to aspiration. This case highlights the management of malignant BEF in a patient using an esophageal stent, emphasizing the importance of a multidisciplinary approach and the interventional strategy in managing complex airway complications. A 69-year-old male with a significant history of chronic alcoholism was admitted to the hospital with acute hypoxic respiratory failure, requiring 4 liters of oxygen via nasal cannula. He presented with a 3-day history of worsening shortness of breath, nausea, vomiting, and dysphagia with choking episodes. The chest X-ray showed a left lower lobe opacity. An esophagram demonstrated a possible bronchoesophageal fistula and a suspected esophageal neoplasm. Esophagogastroduodenoscopy (EGD) revealed an esophagobronchial fistula and an ulcerated 10 cm semicircumferential lesion, with multiple biopsies confirming esophageal squamous cell carcinoma. Bronchoscopy confirmed a perforation of the left main bronchus with fluid seeping from the lesion and significant narrowing due to external compression. An esophageal stent was placed, with subsequent esophagograms showing no leakage (Image) and resolution of symptoms, allowing the patient to gradually wean off oxygen.Bronchoesophageal fistula is a serious complication of esophageal cancer that can lead to recurrent pneumonia and respiratory failure if left untreated. Diagnosis can be challenging due to nonspecific symptoms, but diagnostic tools such as barium esophagography, esophagoscopy, and bronchoscopy are essential. In this case, the placement of an esophageal stent effectively sealed the fistula, demonstrating the efficacy of stenting as a primary treatment for BEF. Prior studies indicate that stenting is the preferred management option for malignant esophago-respiratory fistulas. The significant morbidity associated with BEF emphasizes the need for timely intervention through a multidisciplinary approach that involves pulmonology and gastroenterology. Studies have shown that early diagnosis and stenting can improve respiratory outcomes and reduce hospital stays. The effectiveness of stenting in managing BEF supports its consideration as a primary treatment option for similar cases.This case demonstrates effective management of respiratory complications from malignant BEF through palliative esophageal stenting. Early recognition and coordinated interventional management are essential for preventing progressive respiratory failure and improving outcomes in BEF. Additionally, this case highlights the need for awareness of malignant BEF and the importance of considering stenting as a primary treatment option. This abstract is funded by: None