Are metallic stents really safe? A long-term analysis in lung transplant recipients

Gottlieb, Jens; Fuehner, Thomas; Dierich, Martin; Wiesner, Olaf; Simon, Andrè; Welte, Tobias

doi:10.1183/09031936.00041909

Cited by 79 publications

(80 citation statements)

References 31 publications

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“…However, it is not available in many intensive care units (ICU) and requires special facilities. Metallic stent is effective in reliving symptoms of airway obstruction, facilitating to liberate from ventilator, improving pulmonary function and performance status (50)(51)(52). Compared with poor performance status, patients with malignant central airway obstruction under intermediate performance status have survival benefit after airway stenting (12).…”

Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 99%

“…In one largest series of lung transplant recipients, the 5-year survival was significant lower in patients receiving metallic stent insertion. Re-stenosis and airway bacterial colonization are the major problems (52). Because of severe complication after long term SEMS implantation, the US Food and Drug Administration (FDA) have warned that metallic stent is not advised to treat benign disease.…”

Section: A B Cmentioning

confidence: 99%

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Central airway tumors: interventional bronchoscopy in diagnosis and management

Lin

Chung

2016

J. Thorac. Dis.

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The diagnosis of central airway tumors is usually challenging because of the vague presentations.Advances in visualization technology in bronchoscopy aid early detection of bronchial lesion. Cryotechnology has great impact on endobronchial lesion sampling and provides better diagnostic yield. Airway tumor involvements result in significant alteration in life quality and lead to poor life expectancy. Timely and efficiently use ablation techniques by heat or cold energy provide symptoms relief for central airway obstruction. Prostheses implantation is effective in maintaining airway patency after ablative procedure or external compression. Combined interventional bronchoscopy modalities and other adjunctive therapies have improvement in quality of life and further benefit in survival. This review aims to provide a diagnostic approach to central airway tumors and an overview of currently available techniques of interventional bronchoscopy in managing symptomatic central airway obstruction. Here, we provide a clinical review of interventional bronchoscopy in diagnoses and management of central airway tumors. Keywords Diagnostic modalities Computed tomographyOnly less than 30% patients with tracheal tumors have been diagnosed via chest radiography (14). Traditional CT scan is more sensitive and can provide information on the extent of airway lesions. Newly developed multidetector CT (MDCT) can accurately detect airway tumor locations, natures, quantities (1). The extra luminal anatomy is also clearly depicted. Thus, MDCT is a rapid and non-invasive method to provide comprehensive information about the extent of disease process before surgery or interventional bronchoscopy (1). Visualization of bronchoscopyBronchoscopy is the mainstay to approaching endobronchial lesion under direct vision. In addition to conventionally white light bronchoscopy, autofluorescence (AFB) and narrow band imaging (NBI) are new visualization techniques of bronchoscopy which can aid detection of bronchial mucosa lesions (15). Although the specificity of AFB is low and similar to white light bronchoscopy, there is no doubt in usefulness of detecting early bronchial mucosal lesion and evaluate the margin of mucosal involvement (16,17). NBI is designed to detect angiogenesis and neovascular lesion. The diagnostic accuracy is increased under NBI bronchoscopy (15). Both of them have superior sensitivity comparing with white light bronchoscopy [3][4][5]. Endobronchial ultrasonography (EBUS) is also helpful in evaluating the extent of airway lesion involvement (14,18). Tissue sampling: forceps versus cryotechnologyForceps biopsy under direct bronchoscopic vision is the most common method to obtain tissue sample from endobronchial lesion. However, the size of tissue sample is limited by the forceps size. Small samples with crush artifacts are probably insufficient for accurate diagnosis. The diagnostic yield is only 85% of conventional forceps biopsy and patients usually have to repeat bronchoscopy (2,3).Cryotechnology has been used as a t...

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Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Central airway tumors: interventional bronchoscopy in diagnosis and management

Lin

Chung

2016

J. Thorac. Dis.

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“…Gottlieb and coworkers inserted 111 SEMSs (91% uncovered) in post-LT recipients who developed anastomotic strictures (19). Clinical improvement was seen in 80% cases.…”

Section: Metallic Stents For Post-lt Stricturesmentioning

confidence: 99%

Stents for airway strictures: selection and results

2017

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“…In our previous study involving 61 lung transplant recipients with metal stents, 77% of patients subsequently demonstrated bacterial colonization [3]. Noppen reported an 80% incidence of new bacterial colonization (mainly Staphylococcus aureus) following the insertion of silicone stents in a nontransplant cohort [15].…”

mentioning

confidence: 95%

“…Metallic stents represent the mainstay treatment, but stent-related complications are frequent [3]. In attempting to address some of these drawbacks, biodegradable stents (BDS) have been developed as a temporary alternative in managing benign lesions and represent a novel alternative for obstructive AC in LTx recipients [4][5][6][7].…”

mentioning

confidence: 99%