Malignant Oesophagal Stricture With Airway Involvement: Check the Airway Before You Stent: FG | October 2026

What Did the Study Find?

This tertiary-centre study evaluated 26 patients with malignant oesophagal strictures undergoing same-session upper GI endoscopy and bronchoscopy because of suspected oesophageal–airway involvement.

• 81% had oesophagal cancer and 19% had lung cancer; most had advanced disease.
• Although dysphagia was the commonest referral symptom (42%), CT already demonstrated airway compromise in 65%—often without prominent respiratory symptoms.
• Endoscopy identified an esophago-airway fistula in 46%, despite only 23% being referred with a known fistula.
• Treatment consisted of esophageal stenting alone in 35%, airway stenting alone in 19%, and dual stenting in 27%.
• All patients receiving airway intervention had >50% airway stenosis.
• Critically, after esophageal stenting as the initial intervention, immediate repeat bronchoscopy showed worsening airway compression in one-third of patients.
• New esophago-airway fistula was an important post-stenting complication, occurring in 19% of patients receiving a stent.
• Half required a subsequent endoscopic or bronchoscopic procedure.
• Prognosis was extremely poor: median survival after the combined assessment was only 1.9 weeks.

A Practical Algorithm Emerges

For malignant esophageal strictures with suspected airway involvement:

CT assessment → multidisciplinary GI/respiratory review → bronchoscopy first → esophageal intervention when appropriate → repeat bronchoscopy immediately after esophageal stenting.

If airway narrowing is <50% without fistula**, esophageal stenting alone can generally be considered. With **>50% airway compromise or an esophago-airway fistula, airway and/or dual stenting should be considered. If esophageal stenting creates new severe airway compression, airway stenting or reversal of the esophageal intervention may be required.

Why Does It Matter?

An esophageal stent can relieve dysphagia but its radial force can convert a partially compromised airway into clinically important obstruction. Respiratory symptoms alone are therefore insufficient to identify risk.

GastroAGI Takeaway

In malignant esophageal stenosis, look beyond the esophageal lumen before placing the stent. If CT suggests airway involvement, the safest strategy may be planned same-session bronchoscopy and upper-GI endoscopy, ideally in a tertiary center with both interventional teams available.

The particularly important procedural lesson is: bronchoscopy before—and again after—esophageal stenting.