Lifesaving transcordal stenting for high proximal tracheoesophageal fistulas: a conservative endoscopic approach

Management of non-operable malignant tracheoesophageal fistulas remains challenging, particularly when the communication is located immediately below the vocal cords. We describe a customized transcordal variable-caliber silicone stent assembled intraoperatively from two commercially available stents in three patients with esophageal cancer and high proximal tracheoesophageal fistulas. Preprocedural planning combined endoscopy, contrast-enhanced CT, and three-dimensional reconstructions. All procedures were performed by rigid bronchoscopy under deep sedation with spontaneous ventilation. The devices were deployed without technical complications, achieved fistula exclusion, and allowed oral hydration within 24 h followed by gradual reintroduction of oral feeding. Follow-up was 18, 10, and 8 months. One patient required stent replacement for late prosthetic infection; no other major stent-related complications occurred. This approach provides an immediately available and intraoperatively adjustable option for selected patients with complex proximal airway anatomy when conventional single-caliber or rapidly manufactured patient-specific devices are unsuitable.