Placement of self-expandable bifurcated metallic stents without use of fluoroscopic and guidewire guidance to palliate central airway lesions

Abstract

BackgroundSelf-expandable metallic stents (SEMS) can be used to treat malignant obstructions and fistulas of the central airways. SEMS can be placed using different methods. Recently, a rigid bronchoscope has been used for stent placement without the need for fluoroscopy. We retrospectively evaluated patients for whom SEMS were placed using a rigid bronchoscope, without employing guidewires or fluoroscopy. We describe the intra- and post-procedural complications of the method.MethodsData collected between January 2014 and July 2015 were retrospectively evaluated by reference to hospital records.ResultsThe mean patient age was 58.14 ± 8.48 years (44–72 years) and 13 out of the 14 patients were male. Twelve had lung cancer, one a thyroid papillary carcinoma with a bronchomediastinal fistula, and one an esophageal carcinoma with a tracheoesophageal fistula. Covered metallic Y-shaped stents were placed in all patients. Before placement, argon plasma coagulation was performed on two patients, diode laser treatment on four, and de-obstruction on nine. No procedure-related mortality was noted. Only two patients required follow-up in the intensive care unit; they were moved to a regular ward after two days. No patient required stent replacement or repositioning. The most common early complication was mucus plugs.ConclusionEndobronchial placement of covered self-expandable metallic stents was safe and readily performed in patients with airway obstructions. Neither fluoroscopic nor guidewire guidance was required. Neither patients nor staff were exposed to radiation, and costly guidewire guidance was not necessary. The procedure is cost-effective.

Comparison of silicon and metallic bifurcated stents in patients with malignant airway lesions

“…Silicon Y stents were applied using proper equipment as defined previously . Fully covered SEMS were inserted using the technique, and we described previously without the use of fluoroscopy or a guidewire …”

“…SEMS can also be applied using an RB without using fluoroscopy or a guidewire. 16 In our study, stenting was done without any complications in any of the patients.…”

“…No difference was observed between the groups in the endobronchial methods used before stenting. Seventeen patients had 16 Table 2). None of the patients in the silicon stent group died, whereas one patient in the SEMS group died from haemoptysis and acute myocardial infarction.…”

“…This was optimal for maintaining ventilation; ensuring safe aspiration of secretions and haemorrhage; and applying mechanical desobstruction, dilation and thermal methods. SEMS can also be applied using an RB without using fluoroscopy or a guidewire . In our study, stenting was done without any complications in any of the patients.…”

“…15 Fully covered SEMS were inserted using the technique, and we described previously without the use of fluoroscopy or a guidewire. 16 A chest X-ray was taken after the stents were implanted, and patients were observed for a minimum of 24 h in the hospital. Stent migration, malpositioning, airway laceration due to the procedure and secretion retention were evaluated in all patients under local anaesthesia by an FB 24 h-48 h after the procedure.…”