Internal fixation of the proximal tracheal self-expandable metallic stent (SEMS): migration prevention in high risk patients

The "Hitch-Stitch" for Preventing High Tracheal Stent Migration: Expanding Indications and Extended Experience

BACKGROUND

Airway stenting is a standard treatment option for tracheo-bronchial obstruction and other conditions like tracheo-esophageal fistula (TEF).

METHODS

To prevent stent migration, a percutaneous fixation strategy called the "hitch-stitch" was described in 2016 as an efficient technique. We describe an extended experience of the "hitch-stitch" for silicone stents in high tracheal stenting situations and expanding indications to metal stents.

RESULTS

Seventy-four percutaneous stitches were placed in 54 patients (36 males and 18 females). The mean age of the patients was 42 (±19) years. The indication for stenting was tracheal stenosis in 63/74 (85%) cases and TEF in 11/74 (15%) cases. Silicone stents were used in 56/74 (75.5%) cases while self-expanding metal stents (SEMS) were used in 18/74 (24.5%) cases. The majority of the stents (62/74, 85%) were high tracheal stents. The "hitch-stitch" as an anti-migration strategy had a high success rate, with distal stent migration in only 2 cases (2.7%) as the stitch had given way-these were repositioned and hitched with double stitches. Minor complications included delayed skin healing (2.8%) and suture site infection (1.4%), which was successfully managed with oral antibiotics. Stitch removal was easy with no complications.

CONCLUSION

In this large series of percutaneous "hitch-stitch" as a stent migration prevention strategy, long-term data shows it is safe and effective in an expanded cohort of silicone stents. Its extended utility is the successful application to metal stents, especially in TEF, where the consequences can be deleterious. It is simple to do, with minimal extra requirements and not associated with any significant complications.

Esophagobronchial fistula successfully managed with a self-expandable metallic stent followed by fixation using a silicon Y stent

Esophagobronchial fistula (EBF) formation is a severe complication of advanced thoracic malignancies, that affects the prognosis and quality of life of patients. This study reports the case of an 80‐year‐old man with advanced esophageal cancer, complicated by EBF formation in the left main bronchus proximal to the carina following chemoradiation therapy. A fully covered stent was placed in the left main bronchus but was dislocated on the oral side. The attempt to place a partially covered self‐expandable metallic stent (SEMS) also failed due to stent dislocation on the oral side. To avoid stent dislocation, a partially covered SEMS with a length of 40 mm and a diameter of 16 mm was placed to cover the EBF in the left main bronchus. Then, a silicone Y stent (16 × 13 × 13 mm in outer diameter) was inserted to support the SEMS from the inside. After placing the SEMS and Y stent, the position of the SEMS was stabilized. The patient remained stable with adequate oral intake.

A narrative review of new research progress regarding the use of airway stents in benign airway stenosis

INTRODUCTION

Benign airway stenosis is a severe disease that can result in death with improper treatment. Clinicians must know about airway stents to choose the best one in their daily practice.

AREAS COVERED

PubMed, Embase, and other electronic databases and websites were searched to identify relevant randomized controlled trials and meta-analyses. This review summarizes different types of airway stents and analyzes their advantages and disadvantages.

EXPERT OPINION

Increasing attention has been given to the indications and prognosis of benign airway stenosis treated with different airway stents. With more investigations and data, better alternatives to silicone stents could be developed in the future.

Bronchial stenting in infants with severe bronchomalacia: Technique and outcomes

OBJECTIVES

To report the first use of a balloon expandable bare metal stent for treating infant bronchomalacia.

BACKGROUND

Infant bronchomalacia often requires prolonged mechanical ventilation and can be life-threatening. Effective treatment for severe infant bronchomalacia continues to be elusive. We present three cases of bronchial stenting for no-option or treatment refractory infant bronchomalacia.

METHODS

Three consecutive cases of stenting to relieve conservative treatment refractory severe infant bronchomalacia were performed between February 2019 and December 2020. Initial diagnosis was confirmed with Computed Tomography (CT) angiography. Patients underwent rigid micro laryngoscopy, bronchoscopy, and flexible bronchoscopy to evaluate the airway. Initial conservative management strategies were pursued. Patients failing initial conservative management strategies were considered for rescue bronchial stenting.

RESULTS

Our initial clinical experience with a coronary bare metal stent for these procedures has been favorable. The stent was easy to deploy with precision. We did not encounter stent embolization or migration. There was sufficient stent radial strength to relieve bronchomalacia without causing restenosis or erosion. There was no significant granulation tissue formation. In one patient, the stent was removed after 12 months of somatic growth; this was uneventful and bronchial patency was maintained. There were no complications in any of our patients regarding stent placement and reliability.

CONCLUSION

In cases of three infants with severe bronchomalacia, we found that bronchial stenting with the bare metal coronary stent was effective in relieving bronchial stenosis.