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Abstract
Silicone airway stents are extremely useful for both temporary or long-term management of upper airway obstruction, especially in the proximal half of the trachea and in the subglottic region. They cannot migrate are well tolerated, relatively easy to manage, durable, and generally cause little or no injury to the underlying airway mucosa. They are particularly important as part of the management of subglottic strictures. For patients with postintubation tracheal or laryngotracheal stenosis they can be used to temporize for periods up to a year or two, until the patients' condition is optimal for proceeding with a resection or reconstruction.
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Affiliation(s)
- Joel D Cooper
- Department of Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, White 6, Philadelphia, PA 19104, USA.
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2
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Gompelmann D, Eberhardt R, Schuhmann M, Heussel CP, Herth FJF. Self-expanding Y stents in the treatment of central airway stenosis: a retrospective analysis. Ther Adv Respir Dis 2013; 7:255-63. [PMID: 23823488 DOI: 10.1177/1753465813489766] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Central airway obstruction (CAO) is a life-threatening situation. Stent insertion re-establishes patency of the central airways. Self-expanding metallic Y stents have been available since 2005, widening the spectrum of interventional bronchoscopic techniques. METHODS Retrospective analysis of all patients treated for CAO with a self-expanding metallic Y stent at the Thoraxklinik Heidelberg between May 2005 and January 2009. RESULTS A total of 43 patients aged 26-81 had a metallic Y stent inserted endoscopically for the treatment of CAO; 39 of these patients (90.7%) had CAO due to malignant disease, four patients (9.3%) due to benign disease. In all 43 patients, the Y stent was deployed without any complications. A longitudinal follow up was possible in 32 of the 43 patients. The stents remained in situ for an average of 107.1 days (range 1-640 days). In 29 patients with malignant CAO the stenosis was successfully overcome with a Y stent; 11 of these patients died within 6 weeks following stent insertion. On follow up the remaining 18 patients showed immediate improvement of dyspnoea. Eight out of the 18 patients (44.4%) tolerated the stent without problems, two (11.1%) required further stenting, six (33.3%) had complications such as increased secretions, cough, dyspnoea or granulation tissue formation. The stent was removed in one patient (5.6%) due to increased secretions, and in another (5.6%) as the stent was no longer required due to successful tumour-specific therapy. CONCLUSION Placement of Y stents in symptomatic CAO allows for quick relief of symptoms. Severe complications are rare. Stent removal is possible after successful treatment of the primary tumour. However, the prognostic indicator for survival is the underlying malignancy.
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Affiliation(s)
- Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg Amalienstr, 5 69126 Heidelberg, Germany
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4
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Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and Tracheobronchomalacia in Children and Adults. Chest 2005; 127:984-1005. [PMID: 15764786 DOI: 10.1378/chest.127.3.984] [Citation(s) in RCA: 423] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Tracheomalacia and tracheobronchomalacia are disorders that are encountered in both pediatric and adult medicine. Despite increasing recognition of these disease processes, there remains some uncertainty regarding their identification, causes, and treatment. This article is intended to be a comprehensive review of both the adult and pediatric forms of the diseases, and includes sections on the historical aspects of the disorders, and their classification, associated conditions, histopathology, and natural history. We also review the various modalities that are used for diagnosis as well as the state of the art of treatment, including airway stent placement and surgical intervention.
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Affiliation(s)
- Kelly A Carden
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02446, USA
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5
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Kotsis L, Pápai Z, Udud K, Poller I, Orbán K, Csekeío A. Bilateral bronchial stenting and esophageal intubation for advanced bronchial carcinoma with esophageal invasion. Dis Esophagus 2002; 14:268-70. [PMID: 11869337 DOI: 10.1046/j.1442-2050.2001.00200.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Successive bilateral bronchial stenting (Dumon type) and minimally invasive pull-through esophageal intubation for accompanying malignant bronchial and esophageal involvement was undertaken. External radiation and afterloading brachytherapy for localized endobronchial overgrowth was used. A 13-month survival was achieved using mainly out-patient facilities. During such esophageal intubation, bronchoscopic control is mandatory. Extended complex palliation was obtained using this combined treatment, even in the high-risk stage of advanced tracheobronchial carcinoma with associated esophageal stricture.
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Affiliation(s)
- L Kotsis
- Thoracic Surgical Clinic, Budapest, Pihenoút, Hungary
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6
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Abstract
Bronchogenic carcinoma remains a relentless plague of modern society causing far more deaths than the well-popularized "AIDS epidemic" and secondary only to cardiovascular disease as a cause of death in America. Despite medical advances and treatment breakthroughs, only 40% of newly identified lung cancer patients are "potentially curable". Therefore, a large portion of this patient population will require palliative care and treatment. Surgical palliation is somewhat a misnomer in that most endobrachial lesions causing significant obstruction that result in dyspnea are not amenable to surgical intervention, i.e., operative resectional therapy. The palliative management options of airway obstruction resulting from advanced stage lung cancer will be reviewed, including the historical aspects, development and current use of laser resection, airway stenting, and endobrachial brachytherapy for management of unresectable airway tumors. These modalities frequently are used simultaneously in the same patient and may be used in conjunction with current chemotherapeutic and conventional external-beam radiation protocols.
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Affiliation(s)
- R B Lee
- The Cardiovascular Surgical Clinic, Jackson, Mississippi 39202-1655, USA.
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7
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Abstract
Stenosing airway disease is classified as intraluminal obstruction, extrinsic compression, and malacia by the anatomical site of the lesion. Stenting therapy is indicated for symptomatic relief of life-threatening dyspnea caused by the last two types. Airway stents are made with metal mesh and/or silicone rubber, and currently more than 20 kinds of stent are available. The metal stent (e.g. Gianturco stent, Wallstent) is easy to insert, may not need general anesthesia, and has wider internal lumen. Because it is very hard to reposition or remove, it is mainly used in malignant airway obstruction. Among many kinds of silicone stent, the Dumon stent is most widely used for benign and malignant airway stenoses, but general anesthesia and rigid bronchoscopy are needed for insertion. It can be removed when the stenosing airway disease subsides completely. In many clinical studies, most patients (85-90%) improved immediately after stenting, and procedure-related mortality is low (< 3%) in experienced centers. Stent displacement, mucus impaction, and granulation tissue formation are potential complications. Stenting is one of many effective therapeutic modalities for stenosing central airway disease. Careful patient selection, experiences, and continuous development of new technology will bring better results.
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Affiliation(s)
- H Kim
- Department of Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
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Abdullah V, Yim AP, Wormald PJ, van Hasselt CA. Dumon silicone stents in obstructive tracheobronchial lesions: the Hong Kong experience. Otolaryngol Head Neck Surg 1998; 118:256-60. [PMID: 9482563 DOI: 10.1016/s0194-5998(98)80027-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The insertion of intraluminal stents is an effective method of relieving the distressing symptom of asphyxia in patients with obstructive lesions in the trachea and main-stem bronchi. We report our experience in the use of the studded Dumon silicone stent (Endoxane prosthesis; Axion, Aubagne, France). Between February 1994 and August 1996, 42 stents were placed in 30 patients. Of the 27 patients with a malignant stricture, 10 had carcinoma of the bronchus, 13 carcinoma of the esophagus, and 4 metastatic carcinoma involving the tracheobronchial tree. The benign lesions were made up of two tuberculous strictures and one suprastomal stenosis after tracheostomy. Stents were placed through a rigid bronchoscope with patients under general anesthesia. Postplacement assessment was performed with a 10-point, symptom-based visual analog scale. In eight less urgent cases, forced expiratory volume in 1 second and forced vital capacity were determined before and after surgery. The mean symptomatic improvement on the 10-point scale was 6.1 points, whereas the forced expiratory volume in 1 second (in the eight patients tested) improved by 75%, and the forced vital capacity improved by 54%. The median survival was 2 months for patients with carcinoma of the bronchus and 3 months for patients with carcinoma of the esophagus. Two patients with metastatic carcinoma and all of the patients with the benign lesions were alive and well after 12 months of follow-up. Insertion of the Dumon stent is a simple, safe, and effective method of countering the distressing symptoms arising from obstructive tracheobronchial lesions.
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Affiliation(s)
- V Abdullah
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T
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9
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Witt C, Dinges S, Schmidt B, Ewert R, Budach V, Baumann G. Temporary tracheobronchial stenting in malignant stenoses. Eur J Cancer 1997; 33:204-8. [PMID: 9135489 DOI: 10.1016/s0959-8049(96)00350-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endobronchial stent implantation has been successfully employed in malignant stenoses. The aim of this prospective study was to investigate the temporary use of tracheobronchial stents combined with tumour-specific therapy. All patients received stents for primary palliation of dyspnoea followed by radio- or chemotherapy with the aim of stent removal after reduction of the stenosis. In 22 patients suffering from severe malignant strictures, 34 endobronchial stents (29 Strecker-, 3 Dumon-, 1 Orlowski-, 1 Dynamic-Y-stents) were implanted (in 9 patients, 2 stents were necessary). Patients were treated by irradiation (n = 18) or chemotherapy (n = 4) after stent implantation. Significant improvement of dyspnoea (P < 0.001) and partial oxygen pressure (P < 0.01) was observed. In 11 out of 22 cases (50%), the stents could be removed after successful tumour-specific therapy which led to reduction of stenosis after a mean interval of 31.7 (6-104) days (temporary stenting). During the period of tumour-specific therapy, 9 patients died after a mean interval of 132 (13-347) days (definite stenting). In two cases, stents had to be removed after stent compression, stent dislocation and severe cough. The results suggest that temporary stenting, characterised by subsequent successful tumour-specific therapy, is a new valuable therapeutic strategy. It can "bridge the gap" before tumour-specific therapy can take effect. If tumour-specific therapy is ineffective, definite stenting is the palliative method of choice in severe dyspnoea in bronchial carcinoma.
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Affiliation(s)
- C Witt
- Department of Internal Medicine I, Medical School (Charité), Humboldt University, Berlin, Germany
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11
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Monnier P, Mudry A, Stanzel F, Haeussinger K, Heitz M, Probst R, Bolliger CT. The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers. A prospective, multicenter study. Chest 1996; 110:1161-8. [PMID: 8915214 DOI: 10.1378/chest.110.5.1161] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVE To investigate the safety, efficacy, and tolerance of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancer. DESIGN An 8-month prospective study employing either a rigid bronchoscope or a flexible delivery system for prosthesis insertion. SETTING Multicentric setting involving four teaching hospitals in Switzerland and Germany. PATIENTS Forty patients (29 men, 11 women), average age of 62 years, presenting with an inoperable tracheobronchial cancer. INTERVENTIONS After partial airway recanalization with an Nd-YAG laser, the covered Wallstent was inserted 23 times using a rigid bronchoscope (Rigidstep device), and 27 times using a flexible delivery system (Telestep device) under fluoroscopic and endoscopic visualization. RESULTS Clinical and endoscopic examination at 1, 30, and 90 days showed improvement in the bronchial lumen and in the dyspnea index. No serious complication (death, perforation, hemorrhage, inability to remove an improperly placed prosthesis) was observed during surgery. Late complications included migration (12%), inflammatory granulations or tumor regrowth at the tip of the prosthesis (36%), and symptomatic retention of secretion (38%). CONCLUSIONS Compared with other tracheobronchial prostheses, notably the Dumon stent, the covered Wallstent presents the following advantages: insertion with visual guidance, treatment of extrinsic compressions and esophagobronchial fistulas, and little chance of migration when the prosthesis diameter is chosen correctly. The following disadvantages can be noted: high price; both repositioning and extraction of the released stent are more difficult, though certainly possible; and risk of granulations at the tips of the prosthesis and retention of secretions. Suggestions are made for potential improvements to the stent and insertion system that may result in a significant decrease in early and late complications.
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Affiliation(s)
- P Monnier
- Otolaryngology, Head and Neck Surgery Department, University Hospital CHUV, Lausanne, Switzerland
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12
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Freitag L, Tekolf E, Steveling H, Donovan TJ, Stamatis G. Management of malignant esophagotracheal fistulas with airway stenting and double stenting. Chest 1996; 110:1155-60. [PMID: 8915213 DOI: 10.1378/chest.110.5.1155] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Prognosis of inoperable or recurrent esophageal carcinoma is, at best, poor. Once an esophagotracheal fistula has developed, the overall condition of the patient declines rapidly. Aspiration pneumonia and severe coughing are common. The introduction of esophageal tubes does not always seal the fistula sufficiently and may compromise the airway causing stridor and dyspnea. In 30 patients (25 male, 5 female; age 23 to 74 years; mean, 56 years) with very large fistulas and airway problems, we inserted an airway stent (Dynamic) (n = 12) or an esophageal tube combined with a Dynamic airway stent (n = 18) with the aim of sealing the fistula and restoring patency of the airway and GI passage. The tracheobronchial Dynamic stent was chosen because its slightly concave, flexible posterior silicone membrane adapts ideally to the convex esophageal tube. The stents were well tolerated and significantly improved the quality of life. Of 30 patients, 16 could breathe and swallow unimpaired until shortly before their death. Moderate complaints persisted in five patients, dysphagia in eight patients, and dyspnea in one patient. Mean survival time in the double stent group was significantly greater (110 days) than in the airway stent-only group (24 days) or comparable groups in the literature treated with esophageal tubes only. We conclude that carefully selected patients can benefit from double stenting of esophagus and airways.
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Affiliation(s)
- L Freitag
- Ruhrlandklinik, Center for Pulmonary Medicine and Thoracic Surgery, Essen, Germany
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13
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Tojo T, Iioka S, Kitamura S, Maeda M, Otsuji H, Uchida H, Mori T, Furuse K. Management of malignant tracheobronchial stenosis with metal stents and Dumon stents. Ann Thorac Surg 1996; 61:1074-8. [PMID: 8607659 DOI: 10.1016/0003-4975(96)00010-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tracheobronchial stenosis caused by malignancy is a life- threatening problem. Stenting is one of the treatment modalities and recently has been used widely for the management of such stenosis, but we do not have a clear guide as to which stent should be selected. METHODS We evaluated 25 patients (19 men, 6 women; mean age, 60.7 years; range, 34 to 77 years) received 24 metal stents (four covered with silicone rubber) and three Dumon stents. All 25 patients had severe dyspnea because of airway stenosis caused by malignant tumors. RESULTS Among the 25 patients, airway obstruction due to extrinsic compression by tumor developed in 11 and was treated with a bare metal stent. The airway remained patent in 10 patients. In 16 patients with intraluminal tumor invasion, nine lesions were treated with a bare metal stent, four lesions with a covered metal stent, and the remaining three lesions with a Dumon stent. Recurrent stenosis did not occur in any patient with a covered metal stent or a Dumon stent. However, restenosis occurred in 4 patients with a bare metal stent, all of whom received laser therapy. In all patients, stenting immediately relieved dyspnea. Six patients lived for 32 days to 53 months after stenting, and 19 patients died of primary malignancies with a mean survival of 131.9 days. CONCLUSIONS Metal stents are effective in treating malignant extrinsic tracheobronchial compression. The use of covered metal stents or Dumon stents is preferable for intraluminal stenosis due to malignant growth.
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Affiliation(s)
- T Tojo
- Department of Surgery III, Nara Medical College, Japan
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14
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Ninane V. Endoscopic management of acute respiratory failure related to tracheobronchial malignancies. Support Care Cancer 1995; 3:418-21. [PMID: 8564347 DOI: 10.1007/bf00364983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Endobronchial treatment has an expanding role in the treatment of tracheobronchial tumors. Most patients are treated in this way for the palliation of dyspnea caused by a tumor located in a major airway. In cases where immediate relief is required, prompt control is better achieved by the neodymium-YAG laser or by stents. These two modalities and their indications and limitations in the endoscopic management of acute respiratory failure related to tracheobronchial malignancies are discussed.
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Affiliation(s)
- V Ninane
- Chest Service, Saint-Pierre University Hospital, Brussels, Belgium
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Vergnon JM, Costes F, Bayon MC, Emonot A. Efficacy of tracheal and bronchial stent placement on respiratory functional tests. Chest 1995; 107:741-6. [PMID: 7533070 DOI: 10.1378/chest.107.3.741] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Stent placement is the only available treatment in patients presenting either a localized external compression or a malacia of the tracheobronchial tree. To assess the functional benefit of prosthesis insertion in these indications, we compared functional respiratory values before, immediately after (48 h), and at sometime after (mean, 10.1 months) operation in 24 patients presenting with a bronchial lesion (B group, n = 5) or a lesion of the intrathoracic part (ITT group, n = 9) or of the extrathoracic part of the trachea (ETT group, n = 10). Before treatment, airflow was severely impaired in most patients without significant differences among the groups. After prosthesis insertion, airflow parameters increased [change in forced expiratory volume in 1 s (delta FEV1 = 440 mL; delta peak expiratory flow (PEF) = 0.92 L.s-1; delta maximum expiratory flow 25/75 (delta MEF25/75) = 0.47 L.s-1; and delta forced inspiratory volume in 1 s (delta FIV1 = 310 mL)] and airway resistances (Raws) decreased (delta Raw = -0.43 kPa.s-1.s-1) without any significant variation in either forced vital capacity (FVC) or total lung capacity. Airflow improvement was more apparent in ITT and ETT groups than in the B group. Moreover, inspiratory flow increase and decrease of FEV1/PEF ratio were only observed in the ETT group. This airflow improvement was maintained for a long time after and was associated with a good clinical tolerance. This study supports the clinical and functional benefits of prosthesis placement both in benign and malignant airway compressions for palliative treatment.
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Affiliation(s)
- J M Vergnon
- Department of Chest Diseases and Thoracic Oncology, Hôpital Nord, University Hospital Saint-Etienne, France
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17
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Noppen M, Dhondt E, Meysman M, Monsieur I, Gepts E, Vincken WG. A simplified insertion technique for tracheobronchial silicone stents. Chest 1994; 106:520-3. [PMID: 7774330 DOI: 10.1378/chest.106.2.520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In many patients with central airway obstruction due to extrinsic compression or malacia, insertion of tracheobronchial stents can provide effective and permanent relief. Of the various types of prostheses described, the silicone Dumon-Artemis stents (Medicore, Brussels, Belgium) are probably the most efficient. The use of an elegant and safe specially designed stent introducer system combined with a special bronchoscope is proposed for insertion by Dumon. This combined stent insertion system, however, is relatively expensive and cumbersome, especially for centers where relatively limited numbers of patients are treated. We propose an alternative, simplified insertion technique of silicone Dumon-Artemis stents, which was proven safe and efficient in our series of patients.
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Affiliation(s)
- M Noppen
- Department of Pneumology, University Hospital AZ-VUB, Free University of Brussels, Belgium
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18
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Abstract
Several bronchoscopic techniques for the treatment of patients with tracheobronchial pathology have become available during the last decade. Technical development and additional instruments have provided the bronchoscopist with several alternatives for bronchoscopic therapeutic interventions. The majority of patients with malignant tracheobronchial neoplasm have a dismal prognosis. Palliation is the main aim of the treatment. However, in patients with an early-stage tumor, bronchoscopic treatment may have a curative potential. Resectability, after tumor reduction by a bronchoscopic treatment, may be improved. This article discusses various bronchoscopic techniques, the advantages and disadvantages of each method and the possible benefit which can be derived from such a treatment.
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Affiliation(s)
- G Sutedja
- Department of Pulmonary Medicine, Free University Hospital Amsterdam, Netherlands
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19
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Storck M, Berger H, Liewald F, Sunder-Plassmann L, Dienemann H. Endotracheal balloon dilatation and self-expanding stent (Wallstent) for inoperable tracheomalacia. J Thorac Cardiovasc Surg 1994. [DOI: 10.1016/s0022-5223(94)70366-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nomori H, Kobayashi R, Kodera K, Morinaga S, Ogawa K. Indications for an expandable metallic stent for tracheobronchial stenosis. Ann Thorac Surg 1993; 56:1324-8. [PMID: 8267431 DOI: 10.1016/0003-4975(93)90673-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An expandable metallic stent was used in 9 patients with tracheobronchial stenosis. Of the 8 patients with malignant stenosis, 6 had extrinsic compression and 2 had intraluminal tumor invasion. The 1 patient with nonmalignant stenosis had postreconstruction bronchomalacia and granulation tissue affecting different parts of the tracheobronchial tree. The expandable metallic stent successfully dilated tracheobronchial stenosis due to extrinsic tumor compression and malacia. However, it was not effective for stenosis due to intraluminal tumor invasion or granulation tissue because of the growth of tumor or granulation tissue between the wires of the stent. However, an expandable metallic stent covered with Dacron mesh was effective in 1 patient with intraluminal tumor invasion because tumor growth was blocked by the mesh. We conclude that an expandable metallic stent is effective for tracheobronchial stenosis due to extrinsic tumor compression, but not for stenosis due to intraluminal tumor invasion or granulation tissue.
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Affiliation(s)
- H Nomori
- Department of Surgery, Saiseikai Central Hospital, Tokyo, Japan
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21
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Edell ES, Cortese DA, McDougall JC. Ancillary therapies in the management of lung cancer: photodynamic therapy, laser therapy, and endobronchial prosthetic devices. Mayo Clin Proc 1993; 68:685-90. [PMID: 8350641 DOI: 10.1016/s0025-6196(12)60605-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Endoscopic therapy for cancer that involves the tracheobronchial tree is currently available for two distinct types of lesions: radiographically occult superficial squamous cell carcinoma and advanced malignant tumors that cause severe airway obstruction. Photodynamic therapy, which uses a photosensitizing agent, is effective for managing early superficial squamous cell carcinoma. Neodymium:yttrium-aluminum-garnet laser therapy has been effective in the palliative management of patients with advanced or recurrent malignant obstructive airway lesions, either alone or in combination with intraluminal radiation therapy. Most recently, endobronchial prosthetic devices (stents) have been used in patients with advanced airway obstruction. The use of each of these modalities in the management of lung cancer is reviewed.
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Affiliation(s)
- E S Edell
- Division of Thoracic Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota
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ROLE OF PHOTOTHERAPY, LASER THERAPY, BRACHYTHERAPY, AND PROSTHETIC STENTS IN THE MANAGEMENT OF LUNG CANCER. Clin Chest Med 1993. [DOI: 10.1016/s0272-5231(21)01154-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gaer JA, Tsang V, Khaghani A, Gillbe CE, Townsend ER, Fountain SW, Yacoub MH. Use of endotracheal silicone stents for relief of tracheobronchial obstruction. Ann Thorac Surg 1992; 54:512-6. [PMID: 1380792 DOI: 10.1016/0003-4975(92)90445-a] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In this article we describe our initial experience with bifurcated and longitudinal silicone stents that can be inserted entirely endoscopically. A total of 10 patients were stented; half had upper airways obstruction resulting from malignant disease and half had anastomotic obstruction after single-lung (3 patients), double-lung (1 patient), or heart-lung transplantation (1 patient). All patients derived immediate relief of life-threatening stridor. Stents were in place for between 5 days and 2 1/2 years (mean, 232.9 days). In the patients with malignant disease, the stents have provided effective relief from stridor for the remainder of their lives. In the transplant recipients, the medium-term results are encouraging, with the stents providing effective relief from stridor, although the longitudinal stents have been associated with distal migration, requiring that the stents be replaced on up to five occasions. The stents have not been associated with infection in the nonimmunosuppressed patients, and during the relatively short follow-up period there has been no tissue reaction to the material.
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Affiliation(s)
- J A Gaer
- Thoracic Unit, Harefield Hospital, Middlesex, England
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Terada Y, Matsunobe S, Nemoto T, Tsuda T, Shimizu Y. Palliation of left main bronchus compression due to malignant tumor by intubation via a tracheostomy tube. Chest 1991; 100:1735-7. [PMID: 1720372 DOI: 10.1378/chest.100.6.1735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Intubation of the left main bronchus via a tracheostomy tube was performed in a patient with local recurrence of lung cancer associated with invasion and obstruction of the left main bronchus after right sleeve pneumonectomy. The result was satisfactory not only for preventing asphyxia, but also for maintaining the patency of the airway after extubation of the endotracheal tube.
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Affiliation(s)
- Y Terada
- Respiratory Center, Shiga Health Insurance Hospital, Otsu, Japan
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Freitag L, Firusian N, Stamatis G, Greschuchna D. The role of bronchoscopy in pulmonary complications due to mustard gas inhalation. Chest 1991; 100:1436-41. [PMID: 1935306 DOI: 10.1378/chest.100.5.1436] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Over the last five years we have repetitively treated a group of 21 Iranian soldiers who developed pulmonary complications as a result of severe inhalation injury due to mustard gas during the Iran-Iraq war. Early respiratory manifestations included hemorrhagic inflammation of the tracheobronchial tree accompanied by severe erosions. Secondary complications consisted of chronic infections, suppurative bronchitis, and extensive stenotic process of the entire tracheobronchial tree with life-threatening sequelae. After a delay of up to 15 months, scars, ulcers, and strictures developed in the central airways. Progressive deterioration of gas exchange was common. At this point, bronchoscopy, both diagnostic and therapeutic, was invaluable in evaluating the conditions in these patients since many required multiple therapeutic bronchoscopies. Repeated bougienage of the stenotic tracheobronchial lesions and laser photoresection of scarring tissue was life-saving. The recurrence rate of stenosis was very high, with intervals of less than six months on the average. One pneumonectomy was necessary, with the excised lung showing bronchiectasis and chronic pneumonia. To this date we have performed 146 therapeutic bronchoscopies. In four patients, silicone stents had to be implanted. One patient received brachytherapy and external beam radiation therapy in an effort to prevent continued scarring and life-threatening stenoses of the tracheobronchial tree. Our experience demonstrates the extreme usefulness of bronchoscopy in the diagnosis and treatment of pulmonary complications due to inhalation of poisonous gases.
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Affiliation(s)
- L Freitag
- Ruhrlandklinik, Center for Chest Medicine and Thoracic Surgery, Essen, Germany
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Endoluminale Schienung (Stenting) bei Stenosen des Tracheobronchialsystems. Eur Surg 1991. [DOI: 10.1007/bf02658866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pierce R. Tracheobronchial lasers, brachytherapy and stents. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1990; 20:639-41. [PMID: 1704702 DOI: 10.1111/j.1445-5994.1990.tb00392.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
A dedicated tracheobronchial stent to be used in the treatment of external compression of the main airway is described. This stent is made of molded silicone. Its outside surface bears regularly placed studs to prevent displacement. First results are encouraging. So far, 118 prostheses have been placed in 66 patients. Tolerance was excellent and complications were rare. Migration occurred 12 times: in seven cases an early prototype that was poorly designed had been used. Obstruction was noted in two cases without major problems. Mean follow-up at the time of this writing is three months, with the longest follow-up 19 months.
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Affiliation(s)
- J F Dumon
- Laser Center, CHU Sud, Hôpital Sainte-Marguerite, Marseille, France
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Cooper JD, Pearson FG, Patterson GA, Todd TR, Ginsberg RJ, Goldberg M, Waters P. Use of silicone stents in the management of airway problems. Ann Thorac Surg 1989; 47:371-8. [PMID: 2467629 DOI: 10.1016/0003-4975(89)90375-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report the use of a silicone rubber T tube for the management of complex airway problems in 47 patients during the past 15 years. The tube has been used for palliation in 11 patients with malignant obstruction of the airway, and as the sole treatment or as an adjunct to operation in 36 other patients. Based on the satisfactory results with the use of these tubes, we have utilized silicone stents in the bronchus and bifurcation prostheses at the carina. In the past, we have inserted the T tubes through a tracheostomy stoma. More recently, we have used a technique for endoscopic placement of the T tubes in which the horizontal limb is pulled out through the tracheostomy stoma. This technique facilitates introduction of the tube and maintains the airway during insertion. The use of silicone stents provides an important tool in the management of complicated airway problems, and we anticipate their increased use in the future.
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Affiliation(s)
- J D Cooper
- Division of Thoracic Surgery, University of Toronto, Ontario, Canada
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