Endobronchial stent for malignant airway obstructions (original) (raw)
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Journal of Vascular and Interventional Radiology, 2004
PURPOSE: This study evaluates the outcome of tracheobronchial stent placement in symptomatic patients with malignant disease. MATERIALS AND METHODS: From 1993 to 2002, 30 patients had stents placed for malignant strictures. Five of 30 patients underwent stent placement distal to the mainstem bronchi, 13 received stents in both the proximal and distal airways, and 12 received stents in only the proximal airways. Clinical response and survival were determined from the patients' medical records. A positive clinical response was judged to have occurred if the patient improved in two of these three categories: subjective symptoms (patient-reported), objective signs (clinician-reported), and postprocedural imaging. RESULTS: The condition of 29 of 30 patients improved within 4 weeks of stent placement. The mean survival duration after stent placement was 261 days (SD, . The location of stent placement was not associated with significant differences in clinical improvement or survival (P ؍ .51). Eight patients had additional airway segments that were too diffusely involved in which to place a stent or could not be recanalized. Mean survival in this group with incomplete stent placement was significantly reduced at 24.9 days (SD, 23.1 days), compared with 345.5 days (SD, 436 days) for the remaining patients who underwent complete stent placement (P < .05). Four patients lived less than 10 days after the procedure and three patients (75%) had mediastinal invasion. CONCLUSION: Tracheobronchial stent placement effectively palliates malignant airway obstruction, and clinical improvement is independent of the location in which the stent is implanted. When patients had diffuse or highly obstructive airway involvement and underwent incomplete stent placement, clinical response was also satisfactory, even though survival was worse. Patients with mediastinal invasion were poor candidates for stent placement as a result of their short survival.
Airway stenting for malignant and benign tracheobronchial stenosis
The Annals of Thoracic Surgery, 2003
A variety of techniques have been used to palliate the effects of large airway obstruction. Tracheobronchial stenting is the optimal endoscopic management for obstruction caused by severe extrinsic compression, intraluminal spread of malignant disease or loss of cartilaginous support. Between 1999 and 2004, 50 patients had silicone rubber stents to relieve symptomatic central airway obstruction. Stent placement was performed through a Harrel Universal rigid bronchoscope. The etiology of large airway obstruction included malignant disease in 30/50 (60%); benign disease in 17/50 (34%); and tracheoesophangeal fistula in 3/50 (17%), whilst in 6 of the 50 patients, two or more stents were required to achieve complete airway patency. There were complications in 2/50 patients (4%); however, procedure-or stent-related mortality was null. Most patients (92.5%) had successful airway obstruction palliation. Airway stenting provides immediate and reliable palliation in the majority of patients with malignant and benign central airway obstruction. Multiple stents are frequently required in order to achieve satisfactory airway patency. Pneumon 2006, 19(3):245-251.
Cureus, 2023
The systematic review aims to evaluate the efficacy and safety of endobronchial stent placement for malignant airway obstruction. A comprehensive search was conducted across multiple databases to identify relevant studies. Cohort studies, randomized controlled trials, and case-control studies examining the outcomes of endobronchial stent placement in patients with malignant airway obstruction were included. Data on pre-treatment evaluation, such as pulmonary function testing, dyspnea severity scoring systems, arterial blood gas parameters, imaging, and degree of obstruction, were also collected. Primary outcomes of interest included post-procedure stenosis, pulmonary function testing evaluation, blood gas parameters, and survival outcomes. Secondary outcomes encompassed improvements in clinical status, dyspnea grade, and procedure-related complications. A total of 27 studies met the inclusion criteria and were included in the systematic review. The included studies demonstrated promising outcomes of endobronchial stent placement in managing malignant airway obstruction. Post-procedure airway diameters, pulmonary function testing, and blood gas parameters improved significantly. Survival outcomes varied among studies. Furthermore, endobronchial stent placement was associated with improvements in clinical status and dyspnea grade. Procedure-related complications ranged from pain, hemoptysis and mucus plugging to stent obstruction, migration and pneumothorax. This systematic review suggests that endobronchial stent placement is an effective and safe intervention for managing malignant airway obstruction. It offers significant improvements in post-procedure stenosis, pulmonary function testing, blood gas parameters, and clinical outcomes. However, further studies with larger sample sizes and standardized reporting are warranted to better evaluate the long-term efficacy and safety of endobronchial stent placement for malignant airway obstruction.
Expert Review of Respiratory Medicine, 2020
Background: Airway stenting is an efficacious approach in management of malignant airway disease (MAD) with improvement in survival outcome. Objective: To determine the indications and long-term clinical outcomes of tracheobronchial stenting in patients with MAD. Methods: A cross sectional review of 51 patients who underwent airway stenting from June 2011 to June 2019 was done. Paired t test was used to compare mean difference of clinical characteristics between pre and post airway stenting. Kaplan-Meier curves were used to assess overall survival. Results: 51 patients had stent insertion with mean age 46.63 ± 17.10 years including 27(52.9%) females. Mainly 37(72.5%) patients had esophageal and 06(11.8%) had lung cancer. The main indications were bronchial stenosis 18(35.3%), tracheal stenosis 11(21.6%) and Tracheo-esophageal/bronchial fistula 13(25.5%). Obstruction was intrinsic, extrinsic and mixed in 20(39.2%), 13(25.5%) and 5(9.8%) patients respectively. There was statistically significant mean difference in pre and post procedure oxygen saturation (mean (M)=89.8, standard deviation(SD)=6.70 vs M=95.5,SD=2.54.p =0.001) and performance status (M=3.65,SD=0.6 vs M=2.59,SD=0.83.p=0.001). Overall median survival was 16 ± 3.44weeks, highest amongst patients with intrinsic obstruction (27 ± 6.51weeks). Conclusion: Airway stenting is an effective endoscopic procedure to re-establish airway patency in advance cancer patients with minimal complications, as per our experience.
2011
printing supported by . Visit Chiesi at Stand D.30 SUNDAY, SEPTEMBER 25TH 2011 (r=0.805, p<0.0001), and for 130 normal (r=0.758, p<0.0001) and 82 abnormal sites (r=0.654, p<0.0001). For malignant cases, there was significant correlation in the total 160 sites (r=0.810, p<0.0001), 112 normal (r=0.782, p<0.0001) and 48 abnormal (r=0.564, p<0.0001). Benign cases showed significant correlations in the total 52 sites (r=0.780, p<0.0001), 18 normal (r=0.778, p<0.0001) and 34 abnormal sites (r=0.731, p<0.0001). Conclusions: This EBUS technique was successful in establishing accurate airway measurements for suitable airway stent sizes in interventional procedures, especially in cases with tracheobrochial malacia. P611 Bronchoscopic application of mitomycin-C as adjuvant treatment of postintubation tracheal stenosis Filipa Viveiros, Joana Gomes, Ana Oliveira, Sofia Neves, José Almeida, João Moura e Sá. Pulmonology Service, Centro Hospitalar de Gaia/Espinho, Vila No...
Computed Tomography Measurements for Airway Stent Insertion in Malignant Airway Obstruction
Journal of Bronchology & Interventional Pulmonology, 2010
Background: Metallic airway stents for malignant airway obstruction are considered safe, yet are not without complications. This study reviews the role of computed tomography (CT) airway measurements for planning stent placement in malignant airway obstruction before the actual therapeutic procedure to avoid invasive diagnostic evaluation before the stent placement and to reduce complications. Methods: This study is a retrospective review of information from a stent order database and medical records of patients receiving stents for malignant airway obstruction at a university hospital over a 12-year period. CT scans were used to determine stent diameter by calculating mean diameters of healthy adjacent zones (proximal and distal), stent length (length of diseased airway), and location and number of potential stents. Results of CT planning before bronchoscopy were judged by complication rates. Results: Patient population consisted of 69 patients, 61.7 ± 14.0 years old, 40 males, in whom 92 stents were inserted. The most frequent cause of airway obstructions was tracheobronchial cancer (32). All patients had nitinol stent placement; 66 stents were covered and 26 were uncovered. Follow-up time was 1 to 1067 days (median: 35 days). Complication rate was 10.1% and mainly involved the patients with tracheal obstruction (6). Complications included stent fractures (2), migration (2), granuloma (1), and infectious tracheitis (2). One early death within 24 hours after the procedure was not related to stent placement. Five patients required follow-up therapeutic bronchoscopy to treat the complications. Conclusions: These results suggest that prestent planning by noninvasive method of obtaining CT scan provides optimal stent size and position, possibly avoiding a diagnostic bronchoscopy and reducing complications. Further prospective study is needed to confirm these results because of limitation of this study's design.