Combined oesophageal and airway stenting for malignant oesophageal strictures: a retrospective cohort study and development of a novel algorithm
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".