Palliative treatment of life-threatening hemoptysis with silicone stent insertion in advanced lung cancer

Barisione, Emanuela; Genova, Carlo; Grosso, Marco; Pasquali, M.; Blanco, Alessandro; Felletti, Raffaella; Salio, Mario

doi:10.4081/monaldi.2017.781

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…This technique has been described mainly as a palliative treatment in the context of advanced lung cancer. All reported cases showed good immediate outcomes [ 71 – 73 ]. Cases were published with silicone and covered self-expandable metal stents.…”

Section: Treatmentmentioning

confidence: 99%

Approach to Hemoptysis in the Modern Era

Gagnon

Quigley

Dutau

et al. 2017

Canadian Respiratory Journal

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Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.

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Section: Treatmentmentioning

confidence: 99%

Approach to Hemoptysis in the Modern Era

Gagnon

Quigley

Dutau

et al. 2017

Canadian Respiratory Journal

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“…While bronchoscopic intervention by intubation with an endotracheal tube or placement of endobronchial balloons could offer a temporary relief, endobronchial stent placement offers a more durable protection of the unaffected lung without prolonging mechanical ventilation. Stent placement had been occasionally reported to effectively manage massive hemoptysis in some case report (especially in those who failed to respond to alternative treatments) (22,23,(45)(46)(47). The stent used to seal the airway mainly included the covered metallic and silicone stent.…”

Section: Discussionmentioning

confidence: 99%

“…Bronchoscopic interventions for hemostasis include intubation of endotracheal tube with a greater diameter, balloon tamponade, endobronchial stent, silicone spigot, laser photocoagulation and argon plasma coagulation, most of them have been applied for mildto-moderate hemoptysis only. Successful placement of endobronchial stents, which helped achieve hemostasis for difficult-to-treat massive hemoptysis, has been documented in some case reports (22,23). In these studies, stent placement was usually reserved as the salvage therapy for difficult-to-treat massive hemoptysis by both blockade and separation of the bleeding source, thereby maintaining the patency of central airways.…”

Section: Original Articlementioning

confidence: 99%

Modified silicone stent for difficult-to-treat massive hemoptysis: a pilot study of 14 cases

Zeng¹,

Wu²,

Zhang³

et al. 2020

J Thorac Dis

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Background: Massive hemoptysis is a life-threatening event with limited therapeutic options.Bronchoscopic placement of stents may offer an alternative option for massive hemoptysis. However, traditional silicone stents have not been customized, making it difficult to tailor to individual patient's needs for achieving optimal hemostasis. To investigate the efficacy and safety of the modified silicone stent in patients with difficult-to-treat massive hemoptysis. Method:Between May 2016 and November 2018, we enrolled 14 patients who underwent bronchoscopic placement of the modified silicone stent, which was fabricated manually based on the Y-shaped silicone stent by tailoring and suturing on site. We recorded the technical success, clinical success, and complications.Patients were followed up for recording the recurrence of massive hemoptysis and complications. Results: Placement of the modified silicone stent was successful in all 14 patients with a mean duration of 69.6 minutes (technical success rate: 100%). After stenting, no further massive hemorrhage episodes recurred in 12 patients (clinical success rate: 85.7%). Two cases suffered from recurrent hemoptysis in 4 and 6 days after stenting, respectively. The main complications were sputum plugging, granuloma proliferation and pulmonary infection such as pneumonia. There were no adverse events of stent migration and suture dehiscence. After a median follow-up of 5.8 (range, 0.3-21.3) months, three patients withdrew and seven patients succumbed. Only one patient died of uncontrolled pneumonia which was possibly related to stent placement. Conclusions: The modified silicone stent is an effective and safe gate-keeping therapeutic option for difficult-to-treat massive hemoptysis.

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“…Therapeutic techniques to attempt hemostasis via the bronchoscope include cold saline lavage, local instillation of topical vasoconstrictive agents (epinephrine), and balloon blockers [31,32]. More specialized bronchoscopic techniques for temporary control of bleeding include endobronchial stent tamponade [33], balloon tamponade [34], topical cellulose mesh, or biocompatible glue [6,35].…”

Section: Initial Stabilization and Airway Managementmentioning

confidence: 99%

Management of life-threatening hemoptysis

et al. 2020

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It is estimated that 5-14% of patients presenting with hemoptysis will have life-threatening hemoptysis, with a reported mortality rate between 9 and 38%. This manuscript provides a comprehensive literature review on lifethreatening hemoptysis, including the etiology and mechanisms, initial stabilization, and management of patients. There is no consensus on the optimal diagnostic approach to life-threatening hemoptysis, so we present a practical approach to utilizing chest radiography, computed tomography, and bronchoscopy, alone or in combination, to localize the bleeding site depending on patient stability. The role of angiography and embolization as well as bronchoscopic and surgical techniques for the management of life-threatening hemoptysis is reviewed. Through case presentation and flow diagram, an overview is provided on how to systematically evaluate and treat the bronchial arteries, which are responsible for hemoptysis in 90% of cases. Treatment options for recurrent hemoptysis and definitive management are discussed, highlighting the role of bronchial artery embolization for recurrent hemoptysis.

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Palliative treatment of life-threatening hemoptysis with silicone stent insertion in advanced lung cancer

Cited by 11 publications

References 11 publications

Approach to Hemoptysis in the Modern Era

Approach to Hemoptysis in the Modern Era

Modified silicone stent for difficult-to-treat massive hemoptysis: a pilot study of 14 cases

Management of life-threatening hemoptysis

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