Management of Malignant Esophagotracheal Fistulas With Airway Stenting and Double Stenting

Freitag, Lutz; Tekolf, Edith; Steveling, H.; Donovan, Terrence J.; Stamatis, Georgios

doi:10.1378/chest.110.5.1155

Cited by 149 publications

(84 citation statements)

References 32 publications

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“…Stents can help to seal fistulas between the respiratory tract and the aerodigestive tract [93,110]. Perforation and migration of oesophageal stents is prevented by tracheal stents.…”

Section: Clinical Experience and Resultsmentioning

confidence: 99%

“…The Dynamic stent developed by FREITAG et al [92] (Boston Scientific Corporation, Natlick, MA, USA) is a hybrid stent made from silicone with horseshoe-shaped steel clasps. In their original form, and with individual modifications, they have been successfully used for the sealing of oesophagotracheal fistulas and stump fistulas [92,93]. Other bifurcated prostheses are available from the Hood Company (Hood Laboratories, Decature, GA, USA) and as part of the Dumon set.…”

Section: Equipment and Technical Backgroundmentioning

confidence: 99%

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Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Bolliger¹

2006

Eur Respir J

339

276

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Minimally invasive diagnostic and therapeutic approaches in medicine have been applied for a more selective and tailored approach to reduce patients' morbidity and mortality. The efficacy of interventional pulmonology for palliation of patients with central airways obstruction has been established and its curative potential for intralesional treatment of early cancer has raised great interest in current screening programmes. This is due to the fact that surgical resection and systemic nodal dissection as the gold standard is relatively morbid and risky, especially when dealing with individuals with limited functional reserves due to smoking-related comorbidities, such as chronic obstructive pulmonary disease. Furthermore, such comorbidities have been proven to harbour early stage lesions of several millimetres in size without involvement of nodal disease that may be amenable to local bronchoscopic treatment.Therefore, the success of minimally invasive strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. Maximal preservation of quality of life is a prerequisite in successfully dealing with individuals at risk of harbouring asymptomatic early lung cancer, to prevent aggressive surgical diagnostic and therapeutic strategies since overdiagnosis remains an issue that is heavily debated.In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation and stenting are techniques that can provide immediate relief, in contrast to cryotherapy, brachytherapy and photodynamic therapy with delayed effects. With curative intent, intraluminal techniques that easily coagulate early stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease.

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“…Stents can help to seal fistulas between the respiratory tract and the aerodigestive tract [93,110]. Perforation and migration of oesophageal stents is prevented by tracheal stents.…”

Section: Clinical Experience and Resultsmentioning

confidence: 99%

Section: Equipment and Technical Backgroundmentioning

confidence: 99%

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Bolliger¹

2006

Eur Respir J

339

276

View full text Add to dashboard Cite

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“…For patients who are not candidates for surgery or general anaesthesia, SEMS implantation may provide a good alternative [7]. Covered SEMSs have been used to seal off tracheo-oesophageal fistulas and to avoid aspiration symptoms [8][9][10].…”

mentioning

confidence: 99%

Metallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure

Lin¹,

Lin²,

Chou³

et al. 2008

Eur Respir J

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Stent implantation has been reported to facilitate liberation from mechanical ventilation in patients with respiratory failure due to central airway disease. The present retrospective cohort study sought to evaluate the risk and benefit of stent implantation via bronchoscopy without fluoroscopic guidance in mechanically ventilated patients.From July 2001 to September 2006, 26 patients with acute respiratory failure were recruited. A bronchoscope was inserted through a mouth guard into the space between the tracheal wall and the endotracheal tube. A guide wire was inserted via the flexible bronchoscope to the lesion site. The bronchoscope was reintroduced through the endotracheal tube. Under bronchoscopic visualisation, the delivery catheter was advanced over the guide wire to deploy the stent.These procedures were successfully performed in 26 patients, with 22 stents placed in the trachea and seven in the main bronchus. Of the 26 patients, 14 (53.8%) became ventilator independent during their stay in the intensive care unit. Severe pneumonia was the most common cause, in seven (58.3%) out of 12 patients, for continued ventilator dependence after stenting. Granulation tissue formation was found in seven patients during the follow-up period.It is concluded that metallic stents can be safely implanted without fluoroscopic guidance in patients with respiratory failure, to facilitate ventilator independence.

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“…Furthermore, the esophageal stent can protrude into the lumen of the airway and compromise ventilation (FIGURE 9) [71]. Placement of an airway stent can prevent airway obstruction from the esophageal stent and can help in sealing the fistula [72][73][74].…”

Section: Fistulas and Dehiscences Malignant Tracheobronchial Fistulasmentioning

confidence: 99%

The use of self-expandable metallic stents in the airways in the adult population

Dutau¹,

Musani

Plojoux³

et al. 2014

Expert Review of Respiratory Medicine

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The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.KEYWORDS: airway stenting . benign airway stenosis . bronchoscopy . central airway obstruction . self-expandable metallic stentDumon was the first physician to place a dedicated and specially designed airway stent in 1987 in Marseille. This dedicated stent consisted of a silicone tube with small studs on the external surface to reduce migration [1]. Consequently, several companies started to develop other airway stents with silicone and metal. In the last 20 years, numerous reports have been published about the use of selfexpanding and balloon expandable metal stents for the treatment of tracheobronchial malignant and benign stenoses, tracheobronchomalacia (TBM), fistulas and dehiscences [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].Self-expandable stents are made of a shapememory alloy, generally nitinol (nickel-titanium). When the stent is released, it expands spontaneously to reach its original shape and diameter. On the other hand, balloon expandable metallic stents (the first generation of airway metallic stents) were made of metal (steel) meshes that did not possess a memory shape. A balloon was then necessary to deploy them. Most of these stents had originally been developed for use in the vascular system but were found to be adequate for placement in the central airways after only minor modifications, if any at all. The latest developments include stents made of shape memory alloys and composite stents made from metals and polymers [17][18][19]. But, so far, the Dumon stent (Tracheobronxane Ò , Novatech, La Ciotat, France) remains the most commonly placed stent worldwide. Dumon stents have been the 'gold standard' for the treatment of benign and malignant airway stenoses over the past 20 years [20,21], with two specific designs: straight and Y-shaped (for disease involving the carina) [22]. By the way, it is interesting to notice that, in the Thoracic Endoscopy Unit of Marseille, where the Dumon stent was conceptualized and used, the percentage of silicone stent placement has dropped from 100% in 2000 to 65% in 2013. The remaining 35% of the stents used are now fully covered, selfexpandable, metallic stents (SEMS). This goes to prove that the Dumon stents are not the ideal stents in all situa...

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Management of Malignant Esophagotracheal Fistulas With Airway Stenting and Double Stenting

Cited by 149 publications

References 32 publications

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Metallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure

The use of self-expandable metallic stents in the airways in the adult population

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