Double stent (tracheal and oesophageal)

A patient with inoperable oesophageal cancer of the middle third developed stridor in addition to his dysphagia. Insertion of an oesophageal stent risked compressing the lower trachea at the carina. T protect the airway a ‘Y’-shaped dynamic tracheal stent (Rusch, Kernen, Germany) was placed before a Microvasive Ultraflex stent was placed across the oesophageal tumour.

The upper limit of the tracheal compression and the carina have been marked with radio-opaque markers. The bronchoscope has been removed and using a laryngoscope the dynamic tracheal stent has been placed and confirmed with fluoroscopy.

An endotracheal tube is then placed.

A gastroscope is passed into the oesophagus and a guidewire placed across the tumour. The oesophageal stent is then placed under fluoroscopic control.

The tracheal and oesophageal stents can be seen, the oesophageal not yet fully expanded.