Outcomes, Health-Care Resources Use, and Costs of Endoscopic Removal of Metallic Airway Stents

Alazemi, Saleh; Lunn, William; Majid, Adnan; Berkowitz, David M.; Michaud, Gaëtane; Feller‐Kopman, David; Herth, Felix J.F.; Ernst, Armin

doi:10.1378/chest.09-2682

Cited by 64 publications

(45 citation statements)

References 21 publications

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“…For metallic stents, neoepithelialization with incorporation of the stent within the airway wall can occur as early as 3-6 weeks; complications during removal of these stents were more likely to occur the longer they had been in place (25,26).…”

Section: Discussionmentioning

confidence: 99%

Airway stent complications: the role of follow-up bronchoscopy as a surveillance method

Lee¹,

Labaki²,

Yu³

et al. 2017

J. Thorac. Dis.

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Background: Airway stenting has become an integral part of the therapeutic endoscopic management of obstructive benign and malignant central airway diseases. Despite increased use of airway stents and frequent stent-associated complications, no clear guidelines for surveillance and maintenance exist. This study aim is to elucidate predictive factors associated with development of stent complications, as well as an optimal surveillance period for follow-up bronchoscopy for early detection and possible prevention of stentassociated complications. Compared to all other stents, hybrid stents were more likely to migrate (OR =6.60; 95% CI: 2.16-20.2; P=0.001) or obstruct by secretions (OR =2.53; 95% CI: 1.10-5.84; P=0.03). There were no complications associated with surveillance bronchoscopy.Conclusions: Surveillance bronchoscopy within 4 to 6 weeks of stent placement may be useful for early detection of complications and their subsequent management, regardless of symptomatic status and indication for stent placement. Prospective multicenter studies are needed to compare optimal surveillance methods and the impact on patient mortality, morbidity and healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Airway stent complications: the role of follow-up bronchoscopy as a surveillance method

Lee¹,

Labaki²,

Yu³

et al. 2017

J. Thorac. Dis.

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“…Alazemi et al [33] reported the outcome, health care resource utilization (HRU), and costs of 46 patients who had metallic stent removal after a median in situ duration of 292 days. A total of 80% of metallic stents were placed for benign airway disorder.…”

Section: Discussionmentioning

confidence: 99%

“…Although, the removals of metallic stents were feasible, they were associated with significant complications, HRU, and costs. However, there were fewer complications, HRU, hospital stay, and costs when the stents were in the airways for ≤30 days before their removal as compared to >30 days [33]. Another study by Chan et al [34] showed a higher long-term complication rate in patients who had metallic stent for benign airway disease, but 90% of stents were removed uneventfully.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Majid

Alape²,

Kheir³

et al. 2016

Respiration

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Background: Patients with severe symptomatic expiratory central airway collapse (ECAC) undergo a stent trial to determine whether they are candidate for tracheobronchoplasty. Most stent trials were done using silicone stents. However, there was a higher number of silicone stent-related complications. Objectives: The aim of this study was to evaluate the safety and efficacy of short-term uncovered self-expanding metallic airway stents (USEMAS) in patients with ECAC. Methods: This was a retrospective review. Baseline measurements were compared to those obtained after 7-14 days. Measurements included: Modified Medical Research Council (mMRC), Cough Quality of Life Questionnaire (CQLQ), spirometry testing, and 6-Minute Walk Test (6MWT). Stent- and procedure-related complications were reported. Results: 33 patients (median age, 52 years) underwent the USEMAS trial. Presenting symptoms were dyspnea in 100%, intractable cough in 90.3%, recurrent infection in 42.2%, and inability to clear secretions in 21.4%. Dyspnea, cough, and secretion clearance improved in 88, 70, and 57%, respectively. Overall, there was a significant improvement in mMRC (p < 0.001), CQLQ (p = 0.015), and 6MWT (p = 0.015). There was 1 airway infection, 1 stent migration, and 1 pneumothorax. The median duration of USEMAS was 7 days. All stents were removed without any complications. At the time of stent removal, no granulation tissue was observed in 30.9%, and mild granulation tissue was observed in 69.1%. Conclusion: The short-term USEMAS trial improves respiratory symptoms, quality of life, and exercise capacity with few complications in patients with severe symptomatic ECAC when performed by a multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population.

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“…Management is further complicated by the diffi culty of removing metal stents. 12,13 To our knowledge, no randomized controlled studies have been performed to compare the incidence of complications between different airway stents. and cohort studies.…”

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confidence: 99%

Respiratory Infections Increase the Risk of Granulation Tissue Formation Following Airway Stenting in Patients With Malignant Airway Obstruction

Ost

Shah

Lei

et al. 2012

Chest

103

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Outcomes, Health-Care Resources Use, and Costs of Endoscopic Removal of Metallic Airway Stents

Cited by 64 publications

References 21 publications

Airway stent complications: the role of follow-up bronchoscopy as a surveillance method

Airway stent complications: the role of follow-up bronchoscopy as a surveillance method

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Respiratory Infections Increase the Risk of Granulation Tissue Formation Following Airway Stenting in Patients With Malignant Airway Obstruction

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