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Answer 5
  1. Endoscopic stent placement. Endoscopic placement of a covered metal stent would widen the esophageal lumen in the region of the tumor, improving the patient’s dysphagia. In addition, the stent would cover the tracheoesophageal fistula, thus greatly reducing the risk of aspiration. Photodynamic therapy, endoscopic laser therapy, and alcohol injection all can be used as palliative therapies in patients with malignant dysphagia. None of these 3 modalities, however, can treat the patient’s concomitant tracheoesophageal fistula. A PEG tube would allow the patient to receive nutrition and hydration, but the patient could still develop pneumonia if gastric contents reflux into the esophagus and cross the fistula.

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