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Seo W, Kim HW, Kim JS, Min J. Long term management of people with post-tuberculosis lung disease. Korean J Intern Med 2024; 39:7-24. [PMID: 38225822 PMCID: PMC10790047 DOI: 10.3904/kjim.2023.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases-all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually-a tailored strategy. In the immediate aftermath (0-12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.
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Affiliation(s)
- Wan Seo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyung Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jinsoo Min
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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Kadokura M, Takenaka Y, Yoda H, Yasumura T, Okuwaki T, Tanaka K, Amemiya F. Fracture of a Self-expandable Metallic Stent Inserted for Malignant Gastric Outlet Obstruction. Intern Med 2021; 60:1525-1528. [PMID: 33250468 PMCID: PMC8188040 DOI: 10.2169/internalmedicine.6216-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Duodenal stenting has gradually been established as the first-line treatment for malignant gastric outlet obstruction (GOO). We encountered a case of duodenal stent fracture in a 76-year-old woman with gastric cancer and GOO. She underwent self-expandable metallic stent (SEMS) placement. The SEMS was found to be fractured 4 weeks after its placement. We removed the broken part of the stent and placed a second SEMS. SEMS fracture is a rare and - to the best of our knowledge - unreported complication; hence, clinicians and their patients should be aware of this possibility.
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Affiliation(s)
- Makoto Kadokura
- Department of Gastroenterology, Kofu Municipal Hospital, Japan
| | - Yumi Takenaka
- Department of Gastroenterology, Kofu Municipal Hospital, Japan
| | - Hiroki Yoda
- Department of Gastroenterology, Kofu Municipal Hospital, Japan
| | - Tomoki Yasumura
- Department of Gastroenterology, Kofu Municipal Hospital, Japan
| | - Tetsuya Okuwaki
- Department of Gastroenterology, Kofu Municipal Hospital, Japan
| | - Keisuke Tanaka
- Department of Gastroenterology, Kofu Municipal Hospital, Japan
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Mondoni M, Repossi A, Carlucci P, Centanni S, Sotgiu G. Bronchoscopic techniques in the management of patients with tuberculosis. Int J Infect Dis 2017; 64:27-37. [PMID: 28864395 DOI: 10.1016/j.ijid.2017.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/28/2017] [Accepted: 08/15/2017] [Indexed: 12/27/2022] Open
Abstract
Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis. We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB. We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting) and ablative procedures (both heat and cold therapies).
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Alice Repossi
- Respiratory Unit, Humanitas Gavazzeni Institute, Bergamo, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.
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Abstract
Endobronchial tuberculosis (EBTB) is defined as tuberculous infection of the tracheobronchial tree. The exact pathogenesis is unclear, and it has a heterogenous clinical course. Its diagnosis requires the clinician to have a high index of suspicion based on clinical symptoms and radiological features. Computed tomography and bronchoscopy are useful tools in its evaluation. The goal of treatment is in the eradication of tuberculous bacilli with appropriate anti-tuberculous therapy. Use of corticosteroids is controversial for the prevention of tracheobronchial stenosis. Interventional bronchoscopy or surgical intervention is employed to restore airway patency once significant stenosis occurs.
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Affiliation(s)
- Wen Ting Siow
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System Tower Block, Singapore 119228, Singapore
| | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System Tower Block, Singapore 119228, Singapore
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Ye BW, Lee KC, Hsieh YC, Li CP, Chao Y, Hou MC, Lin HC. Self-Expandable Metallic Stent Placement in Malignant Gastric Outlet Obstruction: A Comparison Between 2 Brands of Stents. Medicine (Baltimore) 2015; 94:e1208. [PMID: 26200641 PMCID: PMC4602996 DOI: 10.1097/md.0000000000001208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Malignant gastric outlet obstruction is a late complication of intraabdominal malignancy. Self-expandable metallic stent placement has been a safe palliative treatment to relieve obstructive symptoms. We aimed to assess the efficacy and safety of metallic stents in our patients and analyzed the clinical outcome of different brands. Seventy-one patients with inoperable gastric outlet obstruction receiving WallFlex enteral stents (WallFlex group) or Bonastents (Bonastent group) since April 2010 were analyzed retrospectively. The overall technical and clinical success rates of stent placement were 100% and 93%, respectively. The baseline characteristics and clinical outcomes including procedure-related complications, restenosis, and reintervention rates were comparable between the 2 groups. However, the Bonastent group had a higher rate of stent fracture than the WallFlex group (13.3% vs 0%, P = 0.03). The mean duration of overall stent patency was 132.7 days. The mean duration of survival was 181.9 days. Resumption of regular diet or low residual diet at day 7 after stent insertion predicted stent patency (hazard ratio [HR]: 0.28, P = 0.01). Cancer with gastric origin (HR: 0.25, P = 0.045) and poststent chemotherapy (HR: 0.38, P = 0.006) predicted lower mortality; however, peritoneal carcinomatosis (HR: 3.09, P = 0.04) correlated with higher mortality. Metallic stent placement is a safe and effective method for relieving gastric outlet obstruction. Except higher rate of stent fracture in the Bonastent group, there is no significant difference in clinical outcomes between the Bonastent group and the WallFlex group.
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Affiliation(s)
- Bing-Wei Ye
- From the Division of Gastroenterology (B-WY, K-CL, Y-CH, C-PL, YC, M-CH, H-CL), Department of Medicine; Cancer Center (YC); Endoscopic Diagnosis and Therapeutic Center (M-CH), Taipei Veterans General Hospital; and Department of Medicine (B-WY, K-CL, Y-CH, C-PL, YC, M-CH, H-CL), National Yang-Ming University School of Medicine, Taipei, Taiwan
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Cho YC, Kim JH, Park JH, Shin JH, Ko HK, Song HY, Choi CM, Shim TS. Tuberculous Tracheobronchial Strictures Treated with Balloon Dilation: A Single-Center Experience in 113 Patients during a 17-year Period. Radiology 2015; 277:286-93. [PMID: 25955577 DOI: 10.1148/radiol.2015141534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of balloon dilation in the treatment of tuberculous tracheobronchial strictures (TTBSs) in a series of 113 patients at a single institution. MATERIALS AND METHODS The institutional review board approved the study and waived the requirement to obtain informed consent. Between 1997 and 2014, under bronchoscopic and fluoroscopic guidance, a total of 167 balloon dilation sessions were performed in 113 consecutive patients (14 male and 99 female patients; mean age, 37 years [age range, 17-73 years]), with a range of one to eight sessions per patient (mean, 1.5 sessions). Outcomes were number and/or frequency of balloon dilations, technical success, primary and secondary clinical success, improvement in respiratory status, airway patency rate, and alternative treatment after balloon dilation. A two-tailed paired t test and the Kaplan-Meier method were used to evaluate the improvement in respiratory status and airway patency rate after balloon dilation, respectively. RESULTS Dilation was successful in 82 patients (73%) after single (n = 67) or multiple (n = 15) balloon dilations, with a mean follow-up of 30.3 months. Clinical failure occurred in 31 patients (27%). In these 31 patients, symptoms recurred 1 day to 113 months (mean, 13 months) after repeat balloon dilations. These 31 patients required alternative treatment, including temporary stent placement (n = 12), cutting balloon dilation (n = 12), radiation-eluting balloon dilation (n = 3), and surgery (n = 4). Before, immediately after, and 1 month after the procedure, pulmonary function test results showed significant improvements in mean forced vital capacity (P < .001), forced expiratory volume in 1 second (P = .001), forced expiratory flow in the midexpiratory phase (P = .020), and peak expiratory flow (P = .005). CONCLUSION Balloon dilation of TTBSs is a safe, minimally invasive primary treatment that relieved symptoms in a large percentage of patients (73%). In patients with TTBSs refractory to balloon dilation, temporary stent placement, cutting balloon dilation, or radiation-eluting balloon dilation can be an alternative treatment.
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Affiliation(s)
- Young Chul Cho
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Jin Hyoung Kim
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Jung-Hoon Park
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Ji Hoon Shin
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Heung Kyu Ko
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Ho-Young Song
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Chang-Min Choi
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Tae Sun Shim
- From the Department of Radiology and Research Institute of Radiology (Y.C.C., J.H.K., J.H.P., J.H.S., H.K.K., H.Y.S.) and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.M.C., T.S.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea
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Cho YC, Kim JH, Park JH, Shin JH, Ko HK, Song HY. Fluoroscopically guided balloon dilation for benign bronchial stricture occurring after radiotherapy in patients with lung cancer. Cardiovasc Intervent Radiol 2013; 37:750-5. [PMID: 24196264 DOI: 10.1007/s00270-013-0735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in patients with benign bronchial stricture occurring after radiotherapy (RT). METHODS From March 2002 to January 2013, ten patients with benign bronchial stricture occurring after RT underwent fluoroscopically guided balloon dilation as their initial treatment. Technical success, primary and secondary clinical success, improvement in respiratory status, and complications were evaluated. The symptomatic improvement period was calculated. RESULTS A total of 15 balloon dilation sessions were performed in ten patients, with a range of 1-4 sessions per patient (mean 1.5 sessions). Technical success was achieved in 100 %. Six of the ten patients exhibited no symptom recurrence and required no further treatment until the end of follow-up (range 4-105 months). Four patients (40 %) experienced recurrent symptom, and two of four patients underwent repeat balloon dilations. The remaining two patients underwent cutting balloon dilation and temporary stent placement, respectively, and they exhibited symptom improvement after adjuvant treatment until the end of our study. Finally, primary clinical success was achieved in six of ten patients (60 %) and secondary clinical success was achieved in eight of ten patients (80 %). The mean symptom improvement period was 61.9 ± 16 months (95 % confidence interval 30.6-93.3). CONCLUSION Fluoroscopically guided balloon dilation seems to be safe and clinically effective for the treatment of RT-induced benign bronchial stricture. Temporary stent placement or cutting balloon dilation could be considered in patients with benign bronchial strictures resistant to fluoroscopically guided balloon dilation.
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Affiliation(s)
- Young Chul Cho
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea,
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8
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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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9
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Cutting Balloon Treatment for Resistant Benign Bronchial Strictures: Report of Eleven Patients. J Vasc Interv Radiol 2010; 21:748-52. [DOI: 10.1016/j.jvir.2010.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 08/20/2009] [Accepted: 01/11/2010] [Indexed: 11/20/2022] Open
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10
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Kwon YS, Kim H, Kang KW, Koh WJ, Suh GY, Chung MP, Kwon OJ. The Role of Ballooning in Patients with Post-tuberculosis Bronchial Stenosis. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.6.431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yong Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Woo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Masan Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Won Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim JH, Shin JH, Song HY, Shim TS, Oh YM, Oh SJ, Moon DH. Liquid (188)Re-filled balloon dilation for the treatment of refractory benign airway strictures: preliminary experience. J Vasc Interv Radiol 2008; 19:406-11. [PMID: 18295701 DOI: 10.1016/j.jvir.2007.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 10/10/2007] [Accepted: 10/10/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To present the preliminary results of beta irradiation with use of liquid rhenium 188 ((188)Re)-filled balloon dilation in the treatment of refractory benign airway strictures. MATERIALS AND METHODS Ten sessions of beta irradiation by using liquid (188)Re-filled balloon dilation were prospectively performed in nine patients with refractory bronchial strictures between 2003 and 2006. Indications for treatment were dyspnea caused by repeat stricture or no response to previous treatment (ie, balloon dilation and/or temporary stent placement or laser therapy) in seven patients and dyspnea caused by exuberant granulation tissue formation at the distal end of the placed stent in two. To assess the treatment efficacy, the authors calculated and compared the mean intervals of interventional treatments before and after dilation with (188)Re and mercaptoacetyltriglycine (MAG(3))-filled balloons. RESULTS Liquid (188)Re-filled balloon dilation was successfully performed in all nine patients, with no procedure-related complications. Immediately after the procedure, all patients showed resolution of their dyspnea. Five patients remained asymptomatic at 5-25-month follow-up. Four patients experienced dyspnea caused by recurrent stricture 1-10 months after dilation. The mean intervals between interventional treatments increased significantly from 3.1 months +/- 2.1 before (188)Re-MAG(3)-filled balloon dilation to 10.8 months +/- 8.8 after (188)Re-MAG(3)-filled balloon dilation in all nine patients (Wilcoxon signed rank test, P = .025). CONCLUSIONS beta irradiation with liquid (188)Re-filled balloon dilation can be safely used for refractory benign airway strictures. A large study with longer follow-up is needed to draw a definite conclusion.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
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12
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Kim JH, Shin JH, Song HY, Shim TS, Ko GY, Yoon HK, Sung KB. Tracheobronchial Laceration After Balloon Dilation for Benign Strictures. Chest 2007; 131:1114-7. [PMID: 17426217 DOI: 10.1378/chest.06-2301] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although balloon dilation is a safe procedure, it can lead to laceration of the airway, causing bleeding, pneumothorax, pneumomediastinum, or mediastinitis. We therefore determined the incidence and clinical significance of tracheobronchial lacerations after balloon dilation for treatment of benign tracheobronchial strictures. METHODS We evaluated 97 patients who had undergone balloon dilation in 124 sessions for the treatment of benign tracheobronchial strictures. The degree of airway laceration was evaluated bronchoscopically. The cumulative airway patency rate after balloon dilation was compared in patients with and without lacerations using Kaplan-Meier survival curves and log-rank testing. RESULTS There were 64 tracheobronchial lacerations (51.6%) during the 124 sessions of balloon dilation. Of these, 60 were superficial and 4 were deep, but there were no incidents of transmural laceration. In patients with lacerations, mild chest pain (n = 5), blood-tinged sputum (n = 21), and pneumomediastinum (n = 2) occurred, but all resolved completely within 24 h. All superficial lacerations healed spontaneously within 1 month, and all deep lacerations healed 2 to 9 months after conservative treatment. During the follow-up period, the median cumulative airway patency period in patients with and without lacerations was 24 and 4 months (p < 0.05), respectively. CONCLUSION Laceration secondary to balloon dilation in the tracheobronchial tree is relatively common but rarely progresses to transmural laceration and may improve patency outcomes.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
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Yoshida H, Mamada Y, Taniai N, Mizuguchi Y, Shimizu T, Aimoto T, Nakamura Y, Nomura T, Yokomuro S, Arima Y, Uchida E, Misawa H, Uchida E, Tajiri T. Fracture of an expandable metallic stent placed for biliary obstruction due to common bile duct carcinoma. J NIPPON MED SCH 2006; 73:164-8. [PMID: 16790985 DOI: 10.1272/jnms.73.164] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report our second case of fracture of a SMART self-expandable metallic stent (Cordis Endovascular, Warren, NJ) placed to treat biliary obstruction due to an unresectable common bile duct carcinoma. An 82-year-old man presented with jaundice. Computed tomography and ultrasonography on admission demonstrated a mass in the lower common bile duct. The mass was identified as a common bile duct obstruction. A SMART stent was inserted. Ten months after stent insertion, two additional SMART stents were inserted to relieve obstructive jaundice due to occlusion of the first stent. Fourteen months after insertion of the first stent, endoscopic examination revealed stenosis of the duodenum due to invasion of the common bile duct carcinoma, prompting us to perform a gastrojejunostomy 1 month later. Three months after gastrojejunostomy, the patient presented with obstructive jaundice and cholangitis. A fracture of one of the stents was then discovered on plain X-ray films and percutaneous transhepatic cholangiography. Two SMART stents were inserted simultaneously. In conclusion, we report the fracture of a SMART stent placed for common bile duct carcinoma. Fracture should be considered as a possible complication after metallic stent insertion.
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Affiliation(s)
- Hiroshi Yoshida
- Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
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Kim JH, Kim YH, Shin JH, Sung DJ, Shim TS, Cho SB, OH YM, Chung KB, Song HY, Cha SH, Park HS, Um JW. Deep tracheal laceration after balloon dilation for benign tracheobronchial stenosis: case reports of two patients. Br J Radiol 2006; 79:529-35. [PMID: 16714758 DOI: 10.1259/bjr/17839516] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We report two cases of deep tracheal laceration in female patients after balloon dilation for benign tracheobronchial stenosis. Immediate post-procedure bronchoscopy and CT including 3D reconstructions showed deep lacerations in the posterior tracheal wall. Clinically, the patients' dyspnoea subsided and there has been no recurrence during follow-up after balloon dilation. On the follow-up 3D-reconstructed CT scans obtained 2 months and 8 months following balloon dilation, respectively, the lacerations had healed completely and there was considerable improvement in lumen size.
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Affiliation(s)
- J H Kim
- Department of Radiology, Korea University College of Medicine, Seoul
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Walser EM. Stent placement for tracheobronchial disease. Eur J Radiol 2005; 55:321-30. [PMID: 15913937 DOI: 10.1016/j.ejrad.2005.03.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 12/17/2022]
Abstract
Early treatment for airway stenoses or occlusions involved open repair with the attendant risks of thoracotomy or sternotomy. With the advent of rigid and, more recently, flexible bronchoscopy, the placement of airway stents has come to the forefront in the treatment of benign and malignant tracheobronchial disease. This paper describes the history of surgical and endoluminal treatment of airway disease and discusses the indications and contraindications for airway stent placement. The advantages and limitations of such therapy are reviewed as well as the procedural details and the imaging evaluation and follow-up of patients undergoing endoluminal treatment. Although the placement of tracheobronchial stents is now primarily performed by interventional pulmonologists, imaging anatomically complex airway disease also requires the skills of an accomplished cross-sectional radiologist. Additionally, interventional radiologists using fluoroscopic guidance and alternative access routes to the airways can salvage failed bronchoscopic procedures and primarily treat selected cases. Due to the importance of pre- and post-procedural imaging in these patients, radiologists should be aware of airway anatomy suitable for stent placement and the appearance of various complications of this procedure.
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Affiliation(s)
- Eric M Walser
- Department of Radiology, Rt 0709, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0709, USA.
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17
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Jaiswal P, Whitaker D, Lang-Lazdunski L, Coonar A. Stenting for tracheobronchial stenosis in tuberculosis. J R Soc Med 2005. [PMID: 15632236 DOI: 10.1258/jrsm.98.1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Parag Jaiswal
- Department of Thoracic Surgery, Guy's Hospital, London, UK
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Jaiswal P, Whitaker D, Lang-Lazdunski L, Coonar A. Stenting for Tracheobronchial Stenosis in Tuberculosis. Med Chir Trans 2005; 98:26-8. [PMID: 15632236 PMCID: PMC1079238 DOI: 10.1177/014107680509800112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Parag Jaiswal
- Department of Thoracic Surgery, Guy's Hospital, London, UK
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Iwamoto Y, Miyazawa T, Kurimoto N, Miyazu Y, Ishida A, Matsuo K, Watanabe Y. Interventional Bronchoscopy in the Management of Airway Stenosis Due to Tracheobronchial Tuberculosis. Chest 2004; 126:1344-52. [PMID: 15486402 DOI: 10.1378/chest.126.4.1344] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To assess the efficacy and complications of interventional bronchoscopic techniques in treating airway stenosis due to tracheobronchial tuberculosis. DESIGN Case series. SETTING Respiratory care centers at two tertiary care referral teaching hospitals in Japan, Hiroshima City Hospital and Okayama Red Cross Hospital. PATIENTS AND INTERVENTIONS A total of 30 patients were admitted to the hospital with a diagnosis of tracheobronchial tuberculosis between January 1991 and January 2002. Of those 11 patients received interventional bronchoscopy, including stent placement, laser photoresection, argon plasma coagulation (APC), balloon dilatation, cryotherapy, and endobronchial ultrasonography (EBUS). One patient with complete bronchial obstruction underwent a left pneumonectomy. RESULTS Six patients underwent stent placement after balloon dilatation, while the remaining five patients underwent only balloon dilatation. In six patients, Dumon stents were successfully placed to reestablish the patency of the central airways. Two patients first had Ultraflex stents implanted but had problems with granulation tissue formation and stent deterioration caused by metal fatigue due to chronic coughing. Dumon stents then were placed within the Ultraflex stents after the patient had received treatment with APC and mechanical reaming using the bevel of a rigid bronchoscope. In four patients, EBUS images demonstrated the destruction of bronchial cartilage or the thickening of the bronchial wall. The main complications of Dumon stents are migration and granulation tissue formation, necessitating stent removal, or replacement, and the application of cryotherapy to the granuloma at the edge of the stent. CONCLUSION Interventional bronchoscopy should be considered feasible for management of tuberculous tracheobronchial stenosis. Dumon stents seem to be appropriate, since removal or replacement is always possible. Ultraflex stents should not be used in these circumstances because removal is difficult and their long-term safety is uncertain. EBUS could provide useful information in evaluating the condition of the airway wall in cases of tracheobronchial tuberculosis with potential for bronchoscopic intervention.
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Affiliation(s)
- Yasuo Iwamoto
- Department of Pulmonary Medicine, Hiroshima City Hospital, 7-33 Naka-Ku, Moto-machi, Hiroshima City, Hiroshima Prefecture, 730-8518 Japan
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Yoshida H, Tajiri T, Mamada Y, Taniai N, Kawano Y, Mizuguchi Y, Arima Y, Uchida E, Misawa H. Fracture of a biliary expandable metallic stent. Gastrointest Endosc 2004; 60:655-8. [PMID: 15472703 DOI: 10.1016/s0016-5107(04)01884-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Hiroshi Yoshida
- First Department of Surgery, Nippon Medical School, Tokyo, Japan
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Kim JH, Shin JH, Shim TS, Yoon CJ, Lim JO, Ko GY, Yoon HK, Sung KB, Song HY. Efficacy and Safety of a Retrieval Hook for Removal of Retrievable Expandable Tracheobronchial Stents. J Vasc Interv Radiol 2004; 15:697-705. [PMID: 15231883 DOI: 10.1097/01.rvi.0000133506.09685.a3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of use of a retrieval hook for removal of retrievable expandable tracheobronchial stents. MATERIALS AND METHODS With fluoroscopic guidance, a retrieval hook was used to remove 45 retrievable expandable tracheobronchial stents in 31 patients. Indications for stent removal included tissue hyperplasia (n = 16), stent migration (n = 10), stent misplacement (n = 2), tumor overgrowth (n = 2), persistent gastrobronchial fistula (n = 1), and incompletely expanded stent (n = 1). Thirteen stents were electively removed after temporary use. The success rate, causes of failure, and complications related to stent removal with a retrieval hook were analyzed. RESULTS Forty-one of 45 stents (91.1%) were successfully removed with a retrieval hook. The following difficulties were encountered: disruption of the polyurethane membrane (n = 3) and an untied drawstring (n = 1). The removal procedure failed in four cases (8.9%) because of excessive tissue hyperplasia (n = 4) in the proximal portion of the stent. The hook wire fractured in two of the four failed cases. The overall complication rate was 4.4% (minor bleeding, n = 2). CONCLUSION For complications with or temporary use of retrievable expandable tracheobronchial stents, removal with a retrievable hook shows promising initial results.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
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Lee KH, Ko GY, Song HY, Shim TS, Kim WS. Benign tracheobronchial stenoses: long-term clinical experience with balloon dilation. J Vasc Interv Radiol 2002; 13:909-14. [PMID: 12354825 DOI: 10.1016/s1051-0443(07)61774-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the safety and long-term efficacy of balloon dilation in the treatment of benign tracheobronchial stenosis. MATERIALS AND METHODS Balloon dilation was performed under fluoroscopic guidance in 59 consecutive patients with benign tracheobronchial stenosis. Most patients had tuberculosis (48 of 59, 81%). Two to three serial balloon insufflations were performed for 5-180 seconds (mean, 85 sec) with inflation pressures as high as 16 atm with use of 6-20-mm-diameter balloon catheters. Patients with clinical evidence of restenosis underwent repeat balloon dilation. Patients were followed for 12-42 months (mean, 32 mo). RESULTS A total of 101 balloon dilation sessions were performed in 59 patients, with a range of one to four sessions per patient (mean, 1.7 sessions). Initial symptomatic improvement was achieved in 49 (83%) of the 59 patients; however, during the follow-up period, 39 (80%) of the 49 patients experienced recurrence of their symptoms. The primary patency rates at 3, 6, 9, 12, 18, 24, and 32 months were 92%, 60%, 45%, 24%, 20%, 20%, and 20%, respectively. The secondary patency rates at 3, 6, 9, 12, 18, 24, and 32 months were 92%, 87%, 75%, 43%, 43%, 43%, and 43%, respectively. Procedure-related major complications of deep mucosal laceration (n = 2) and bronchospasm (n = 1) occurred in three patients, but they experienced no subsequent problems. CONCLUSION Although the recurrence rate is high during the long-term follow-up period, balloon dilation seems to be a safe primary treatment modality for benign tracheobronchial stenoses and has an acceptable secondary patency rate.
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Affiliation(s)
- Kwang-Hun Lee
- Departments of Diagnostic Radiology and Research, Institute of Radiological Science, Yonesei University College of Medicine,Yong Dong Severance Hospital, Seoul, South Korea
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Chhajed PN, Malouf MA, Glanville AR. Bronchoscopic dilatation in the management of benign (non-transplant) tracheobronchial stenosis. Intern Med J 2001; 31:512-6. [PMID: 11767864 DOI: 10.1046/j.1445-5994.2001.00135.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tracheobronchial stenosis in the adult patient is a recognized postoperative complication of sleeve resection or lung transplantation, but also occurs in medical conditions such as sarcoidosis, tuberculosis, postintubation/tracheostomy or post-radiation. AIMS To assess the response of bronchoscopic dilatation in the management of benign (non-transplant) tracheobronchial stenosis and the longevity of symptomatic relief. METHODS Eight patients underwent bronchoscopic dilatation for benign (non-transplant) tracheobronchial stenosis. The indications were post-tuberculous bronchostenosis (n = 3), post-tracheostomy/endotracheal intubation strictures (n = 3), postradiation bronchostenosis (n = 1) and narrowing of the tracheal lumen following a muscle flap surgery for tracheoesophageal fistula (n = 1). RESULTS Dilatation alone was effective in the management of four patients (50%). Two patients had stent placement postdilatation, one patient had tracheal resection and primary anastomosis and one patient had laser ablation for restenosis followed by balloon dilatation. All patients had clinical improvement. One patient was successfully weaned off mechanical ventilation and extubated. There was no procedure-related mortality and all patients were alive and well at the time of reporting, with a mean duration since procedure of 123 +/- 105 (range 8-340) weeks. The complications observed were granuloma formation at the site of laser excision and restenosis, each in one patient. CONCLUSIONS Bronchoscopic dilatation is a safe and effective modality in the initial assessment and management of benign tracheobronchial stenosis. Stent placement and Nd:YAG laser therapy complement a dilatation procedure in the combined bronchoscopic treatment of benign tracheobronchial stenosis.
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Affiliation(s)
- P N Chhajed
- Heart Lung Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.
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