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McGrath DJ, Thiebes AL, Cornelissen CG, O'Brien B, Jockenhoevel S, Bruzzi M, McHugh PE. Evaluating the interaction of a tracheobronchial stent in an ovine in-vivo model. Biomech Model Mechanobiol 2017; 17:499-516. [PMID: 29177931 DOI: 10.1007/s10237-017-0974-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/28/2017] [Indexed: 12/19/2022]
Abstract
Tracheobronchial stents are used to restore patency to stenosed airways. However, these devices are associated with many complications such as stent migration, granulation tissue formation, mucous plugging and stent strut fracture. Of these, granulation tissue formation is the complication that most frequently requires costly secondary interventions. In this study a biomechanical lung modelling framework recently developed by the authors to capture the lung in-vivo stress state under physiological loading is employed in conjunction with ovine pre-clinical stenting results and device experimental data to evaluate the effect of stent interaction on granulation tissue formation. Stenting is simulated using a validated model of a prototype covered laser-cut tracheobronchial stent in a semi-specific biomechanical lung model, and physiological loading is performed. Two computational methods are then used to predict possible granulation tissue formation: the standard method which utilises the increase in maximum principal stress change, and a newly proposed method which compares the change in contact pressure over a respiratory cycle. These computational predictions of granulation tissue formation are then compared to pre-clinical stenting observations after a 6-week implantation period. Experimental results of the pre-clinical stent implantation showed signs of granulation tissue formation both proximally and distally, with a greater proximal reaction. The standard method failed to show a correlation with the experimental results. However, the contact change method showed an apparent correlation with granulation tissue formation. These results suggest that this new method could be used as a tool to improve future device designs.
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Affiliation(s)
- Donnacha J McGrath
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland
| | - Anja Lena Thiebes
- Department of Biohybrid and Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, ITA-Institut für Textiltechnik, RWTH Aachen University and at AMIBM Maastricht University, Maastricht, The Netherlands, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Christian G Cornelissen
- Department of Biohybrid and Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, ITA-Institut für Textiltechnik, RWTH Aachen University and at AMIBM Maastricht University, Maastricht, The Netherlands, Pauwelsstr. 20, 52074, Aachen, Germany.,Department for Internal Medicine - Section for Pneumology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Barry O'Brien
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, ITA-Institut für Textiltechnik, RWTH Aachen University and at AMIBM Maastricht University, Maastricht, The Netherlands, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Mark Bruzzi
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland
| | - Peter E McHugh
- Biomechanics Research Centre (BMEC), Biomedical Engineering, College of Engineering and Informatics, NUI Galway, Galway, Ireland.
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Abstract
This review comprehensively describes recent advances in the management of malignant central airway obstruction (CAO). Malignant CAO can be a dramatic and devastating manifestation of primary lung cancer or metastatic disease. A variety of diagnostic modalities are available to provide valuable information to plan a therapeutic intervention. Clinical heterogeneity in the presentation of malignant CAO provides opportunities to adapt and utilize endoscopic technology and tools in many ways. Mechanical debulking, thermal tools, cryotherapy and airway stents are methods and instruments used to rapidly restore airway patency. Delayed bronchoscopic methods, such as photodynamic therapy (PDT) and brachytherapy can also be utilized in specific non-emergent situations to establish airway patency. Although data regarding the success and complications of therapeutic interventions are retrospective and characterized by clinical and outcome measure variability, the symptoms of malignant CAO can often be successfully palliated. Assessment of risks and benefits of interventions in each individual patient during the decision-making process forms the critical foundation of the management of malignant CAO.
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Affiliation(s)
- Lakshmi Mudambi
- Division of Pulmonary, VA Portland Health Care System, Oregon Health & Science University, Portland, OR, USA
| | - Russell Miller
- Division of Pulmonary, Interventional Pulmonology, Naval Medical Center, San Diego, CA, USA
| | - George A Eapen
- Division of Interventional Pulmonology, University of Texas-MD Anderson Cancer Center, Houston, TX, USA
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Temporary Endobronchial Stent as a Bridge to Corrective Surgery For Severe Kyphoscoliosis-associated Central-Airway Extrinsic Compression. J Bronchology Interv Pulmonol 2017; 23:331-335. [PMID: 26496091 DOI: 10.1097/lbr.0000000000000221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kyphoscoliosis is known to compromise lung function, with the primary mechanism being reduced chest wall compliance with a resultant restrictive pulmonary physiology. Severe scoliosis can also cause extrinsic compression of the central airways, leading to recurrent respiratory infections, lobar atelectasis, and potentially acute respiratory failure. Definitive therapy is corrective surgery of the spine. However, patients with severe scoliosis are at a potentially high risk of perioperative pulmonary complications. To our knowledge, we report the first successful use of retrievable endobronchial stents as a bridge to corrective surgery for kyphoscoliosis-associated complete central-airway extrinsic compression in a patient who was considered as too high risk for surgical correction due to her respiratory status. After surgery, the stents were removed and our patient experienced sustained improvement in pulmonary function and the clinical respiratory status.
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An ovine in vivo framework for tracheobronchial stent analysis. Biomech Model Mechanobiol 2017; 16:1535-1553. [DOI: 10.1007/s10237-017-0904-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/27/2017] [Indexed: 12/19/2022]
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55
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Biomechanical Properties of Airway Stents: Implications for Clinical Practice. J Bronchology Interv Pulmonol 2017; 23:89-91. [PMID: 27058709 DOI: 10.1097/lbr.0000000000000267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Murgu SD, Egressy K, Laxmanan B, Doblare G, Ortiz-Comino R, Hogarth DK. Central Airway Obstruction. Chest 2016; 150:426-41. [DOI: 10.1016/j.chest.2016.02.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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McGrath D, O’Brien B, Bruzzi M, Kelly N, Clauser J, Steinseifer U, McHugh P. Evaluation of cover effects on bare stent mechanical response. J Mech Behav Biomed Mater 2016; 61:567-580. [DOI: 10.1016/j.jmbbm.2016.04.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/25/2016] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
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Interventional Bronchoscopy in 2015. Removing Endoluminal and Methodological Obstructions. Ann Am Thorac Soc 2016; 12:1265-6. [PMID: 26372802 DOI: 10.1513/annalsats.201507-409ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Godoy MCB, Saldana DA, Rao PP, Vlahos I, Naidich DP, Benveniste MF, Erasmus JJ, Marom EM, Ost D. Multidetector CT evaluation of airway stents: what the radiologist should know. Radiographics 2015; 34:1793-806. [PMID: 25384279 DOI: 10.1148/rg.347130063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Airway stents are increasingly used to treat symptomatic patients with obstructive tracheobronchial diseases who are not amenable to surgical resection or who have poor performance status, precluding them from resection. The most common conditions that are treated with tracheobronchial stents are primary lung cancer and metastatic disease. However, stents have also been used to treat patients with airway stenosis related to a variety of benign conditions, such as tracheobronchomalacia, relapsing polychondritis, postintubation tracheal stenosis, postoperative anastomotic stenosis, and granulomatous diseases. Additionally, airway stents can be used as a barrier method in the management of esophagorespiratory fistulas. Many types of stents are available from different manufacturers. Principally, they are classified as silicone; covered and uncovered metal; or hybrid, which are made of silicone and reinforced by metal rings. The advantages and disadvantages of each type of airway stent are carefully considered when choosing the most appropriate stent for each patient. Multidetector computed tomography plays an important role in determining the cause and assessing the location and extent of airway obstruction. Moreover, it is very accurate in its depiction of complications after airway stent placement.
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Affiliation(s)
- Myrna C B Godoy
- From the Departments of Diagnostic Radiology (M.C.B.G., D.A.S., M.F.B., J.J.E., E.M.M.) and Pulmonary Medicine (D.O.), University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 371, Houston, TX 77030; Department of Radiology, St George's Hospital NHS Trust, London, England (P.P.R., I.V.); and Department of Radiology, Langone Medical Center, New York University, New York, NY (D.P.N.)
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Ost DE. Response. Chest 2015; 148:e161-e162. [PMID: 26527446 DOI: 10.1378/chest.15-1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- David E Ost
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
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61
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Ost DE, Ernst A, Grosu HB, Lei X, Diaz-Mendoza J, Slade M, Gildea TR, Machuzak M, Jimenez CA, Toth J, Kovitz KL, Ray C, Greenhill S, Casal RF, Almeida FA, Wahidi M, Eapen GA, Yarmus LB, Morice RC, Benzaquen S, Tremblay A, Simoff M. Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry. Chest 2015; 148:450-471. [PMID: 25741903 DOI: 10.1378/chest.14-1530] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There are significant variations in how therapeutic bronchoscopy for malignant airway obstruction is performed. Relatively few studies have compared how these approaches affect the incidence of complications. METHODS We used the American College of Chest Physicians (CHEST) Quality Improvement Registry, Evaluation, and Education (AQuIRE) program registry to conduct a multicenter study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was the incidence of complications. Secondary outcomes were incidence of bleeding, hypoxemia, respiratory failure, adverse events, escalation in level of care, and 30-day mortality. RESULTS Fifteen centers performed 1,115 procedures on 947 patients. There were significant differences among centers in the type of anesthesia (moderate vs deep or general anesthesia, P < .001), use of rigid bronchoscopy (P < .001), type of ventilation (jet vs volume cycled, P < .001), and frequency of stent use (P < .001). The overall complication rate was 3.9%, but significant variation was found among centers (range, 0.9%-11.7%; P = .002). Risk factors for complications were urgent and emergent procedures, American Society of Anesthesiologists (ASA) score > 3, redo therapeutic bronchoscopy, and moderate sedation. The 30-day mortality was 14.8%; mortality varied among centers (range, 7.7%-20.2%, P = .02). Risk factors for 30-day mortality included Zubrod score > 1, ASA score > 3, intrinsic or mixed obstruction, and stent placement. CONCLUSIONS Use of moderate sedation and stents varies significantly among centers. These factors are associated with increased complications and 30-day mortality, respectively.
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Affiliation(s)
- David E Ost
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Horiana B Grosu
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiudong Lei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Javier Diaz-Mendoza
- The Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Mark Slade
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, England
| | - Thomas R Gildea
- Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH
| | - Michael Machuzak
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Carlos A Jimenez
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kevin L Kovitz
- University of Illinois Hospital & Health Sciences Center, Chicago, IL
| | - Cynthia Ray
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI
| | - Sara Greenhill
- Chicago Chest Center Interventional Pulmonology, Elk Grove Village, IL
| | - Roberto F Casal
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Francisco A Almeida
- Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH
| | - Momen Wahidi
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Raleigh, NC
| | - George A Eapen
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Rodolfo C Morice
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Alain Tremblay
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Simoff
- The Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
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62
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Ost DE, Ernst A, Grosu HB, Lei X, Diaz-Mendoza J, Slade M, Gildea TR, Machuzak MS, Jimenez CA, Toth J, Kovitz KL, Ray C, Greenhill S, Casal RF, Almeida FA, Wahidi MM, Eapen GA, Feller-Kopman D, Morice RC, Benzaquen S, Tremblay A, Simoff M. Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life. Chest 2015; 147:1282-1298. [PMID: 25358019 DOI: 10.1378/chest.14-1526] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness. METHODS This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D. RESULTS Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements. CONCLUSIONS Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.
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Affiliation(s)
- David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiudong Lei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Javier Diaz-Mendoza
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Mark Slade
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, England
| | - Thomas R Gildea
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kevin L Kovitz
- University of Illinois Hospital and Health Sciences Center, Chicago, IL
| | - Cynthia Ray
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Sara Greenhill
- Department of Pulmonary and Critical Care Medicine, Boston University, Boston, MA; Department of Interventional Pulmonology, Chicago Chest Center, Chicago, IL
| | - Roberto F Casal
- Department of Internal Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC
| | | | - Momen M Wahidi
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Feller-Kopman
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Rodolfo C Morice
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sadia Benzaquen
- Department of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX; Department of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Alain Tremblay
- Department of Pulmonary and Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Simoff
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Terasaki J, Shah S, Schnadig V, Valentine V. Airway complication contributing to disseminated fusariosis after lung transplantation. Transpl Infect Dis 2014; 16:621-4. [DOI: 10.1111/tid.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/12/2013] [Accepted: 02/18/2014] [Indexed: 11/26/2022]
Affiliation(s)
- J.M. Terasaki
- Texas Transplant Center; University of Texas Medical Branch; Galveston Texas USA
| | - S.K. Shah
- Texas Transplant Center; University of Texas Medical Branch; Galveston Texas USA
| | - V.J. Schnadig
- Texas Transplant Center; University of Texas Medical Branch; Galveston Texas USA
| | - V.G. Valentine
- Texas Transplant Center; University of Texas Medical Branch; Galveston Texas USA
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64
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Weisse C. Insights in tracheobronchial stenting and a theory of bronchial compression. J Small Anim Pract 2014; 55:181-4. [DOI: 10.1111/jsap.12209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grosu HB, Eapen GA, Morice RC, Jimenez CA, Casal RF, Almeida FA, Sarkiss MG, Ost DE. Stents are associated with increased risk of respiratory infections in patients undergoing airway interventions for malignant airways disease. Chest 2014; 144:441-449. [PMID: 23471176 DOI: 10.1378/chest.12-1721] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Long-term complications of therapeutic bronchoscopy include infections and airway restenosis due to tumor. No studies have compared the incidence rates of infection in patients with stents with those without stents. We hypothesized that patients with stents would have a higher incidence of lower respiratory tract infections than would patients without stents. METHODS We conducted a retrospective cohort study, covering the period September 2009 to August 2011, of patients who had therapeutic bronchoscopy for malignant airways disease. Outcomes recorded were lower respiratory tract infection and airway restenosis by tumor. RESULTS Seventy-two patients had therapeutic bronchoscopy for malignant airways disease. Twenty-four of these patients had one or more stents placed. Twenty-three of the 72 patients (32%) developed lower respiratory tract infections. Stents were associated with an increased risk of infection (hazard ratio [HR], 3.76; 95% CI, 1.57-8.99; P = .003). The incidence rate of lower respiratory tract infection was 0.0057 infections per person-day in patients with stents vs 0.0011 infections per person-day in patients without stents. The incidence rate difference, 0.0046 infections per person-day, was significant (95% CI, 0.0012-0.0081; P = .0002). Restenosis due to tumor overgrowth was associated with more severe obstruction at baseline (obstruction ≥ 50% vs < 50% preprocedure; HR, 13.71; 95% CI, 1.75-107.55; P = .013). CONCLUSION Therapeutic bronchoscopy with stent placement is associated with a higher risk of infection than is therapeutic bronchoscopy alone. If ablative techniques reopen the airway and there is a good chance that the tumor may respond to chemotherapy and/or radiation, a strategy of initially holding off on stenting may be warranted.
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Affiliation(s)
- Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rodolfo C Morice
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto F Casal
- Department of Pulmonary Medicine, Baylor College of Medicine, Houston, TX
| | - Francisco A Almeida
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic, Cleveland, OH
| | - Mona G Sarkiss
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
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66
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Javaid MR, Yusuf AM. An instant rare complication: a fractured metallic pyloric stent. BMJ Case Rep 2013; 2013:bcr-2012-007695. [PMID: 23345482 DOI: 10.1136/bcr-2012-007695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Metallic pyloric stenting (also termed as metallic enteral stenting) performed endoscopically, stands as first-line treatment for malignant gastric outlet obstruction. With reported evidence, these self-expandable metallic stents (SEMS) re-enable oral food intake, preventing patients having to face invasive techniques such as surgical gastroenterostomy. We report a patient having received a covered pyloric SEMS insertion following a tumour growth causing stenosis in the gastric antropyloric region. After 3 weeks, the patient presented with a fracture of the pyloric SEMS, a rare complication, resulting in a second pyloric SEMS insertion.
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