Successful endoscopic stenting of a tracheoesophageal fistula in a post-laryngectomy patient with negative imaging

Background Tracheoesophageal fistula (TEF) is a rare but serious condition that may occur following malignancy, surgery, or radiotherapy. Diagnosis can be challenging, particularly when initial imaging studies are negative. Case Presentation We report the case of a 76-year-old female with a history of laryngeal squamous cell carcinoma treated with total laryngectomy, permanent tracheostomy, and adjuvant radiotherapy. She presented with progressive aspiration symptoms, including coughing during swallowing and food particles in the tracheostomy tube. Initial barium swallow imaging was unremarkable. However, esophagogastroduodenoscopy revealed a tracheoesophageal fistula in the upper esophagus. Intervention: The patient underwent successful placement of a fully covered self-expanding metal esophageal stent under endoscopic and fluoroscopic guidance. Outcome: Following the procedure, the patient experienced complete resolution of aspiration symptoms. A follow-up contrast study at 3 weeks confirmed fistula closure with normal esophageal transit. At 3-month clinical follow-up, no recurrence was observed. Conclusion This case highlights that TEF may be present despite negative imaging and underscores the importance of early endoscopic evaluation in patients with persistent aspiration symptoms. In selected high-risk patients, single-stage esophageal stenting can provide effective and durable fistula closure.