Retrieval of tracheobronchial foreign bodies by short flexible endoscopy in children

Soong, Wen‐Jue; Tsao, Pei Chen; Lee, Yu-Sheng; Yang, Chia‐Feng

doi:10.1016/j.ijporl.2017.01.033

Cited by 24 publications

(63 citation statements)

References 21 publications

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“…This combined DFAE and TFAE in the same session has actually decreased waiting time, medical expense, and stress on both physicians and patients on one hand, and avoided more invasive interventions and their associated iatrogenic damages on the other hand. These benefits have already been demonstrated in the previous reports [ 12 – 21 ].…”

Section: Discussionsupporting

confidence: 78%

“…However the latter two more invasive interventions require arduous measures such as transportation, operation room service, general anesthesia, endotracheal intubation and mechanical ventilation, or even ECLS, all of these interventions are more complicated and risky in these very small sick children. Further, a rigid instrument such as the RE may itself distort and damage their fragile upper and low airway lumens, and is inappropriate or incapable of managing stent associated problems and lesions [ 14 – 21 ]. Though the facilities and capabilities of both RE and surgery are available in our center, these are not our priorities of management.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic flexible airway endoscopy of small children in a tertiary referral center—11 years’ experience

et al. 2017

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ObjectivesUse of therapeutic flexible airway endoscopy (TFAE) is very limited in pediatrics. We report our clinical experiences and long term outcomes of TFAE in small children from a single tertiary referral center.MethodsThis is a retrospective cohort study. Small children with their body weight no more than 5.0 kg who had received TFAE between 2005 and 2015 were enrolled. Demographic information and outcomes were reviewed and analyzed from medical charts and TFAE videos.ResultsA total of 313 TFAE were performed in 225 children. The mean age was 3.50 ± 0.24 (0.01–19.2) months old; the mean body weight was 3.52 ± 0.65 (0.57–5.0) kg. A noninvasive ventilation technique, without mask or artificial airway, was applied to support all the procedures. TFAE included laser therapy (39.6%), balloon dilatation plasty (25.6%), tracheal intubation (24.3%) and metallic stent placement (6.4%). Short-length endoscopes of 30–35 cm were used in 96%. All TFAE were successfully completed without serious adverse events or mortality. Mean procedural time was 27.6 ± 16.1 minutes. TFAE resulted in successful extubation immediately in 67.2% (45/67) and 62.8% (118/188) were able to wean off their positive pressure ventilation support in 7 days after procedures. By the end of this study, these TFAE averted the originally suggested airway surgeries in 93.8% (61/65), as benefited from laser therapy, stent implantation, and balloon dilatation plasty.ConclusionsThe TFAE modality of using short-length endoscopes as supported with this noninvasive ventilation and ICU support is a viable, instant and effective management in small children. It has resulted in rapid weaning of respiratory supports and averted more invasive rigid endoscopy or airway surgeries.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Therapeutic flexible airway endoscopy of small children in a tertiary referral center—11 years’ experience

et al. 2017

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“…Major stent-associated problems included obstructive granulation formation, lumen narrowing at the stent ends, infection, stent distortion and fracture. In addition to the medical management, mechanical interventions were performed by TFE with forceps debridement, laser ablation and BDP [ 12 , 15 – 21 ]. Forceps debridement and laser (Diode, Dornier MedTech®) ablation could remove granulation tissues ( Fig 5 ).…”

Section: Resultsmentioning

confidence: 99%

“…It is a retrospective study from a single institution with no control group for comparison. Detailed description on the techniques of TFE and NIV of TB BEMS placement and subsequent management such as laser ablation, BDP and stent retrieval are beyond the theme of this study, but they were discussed in our previous published papers [ 15 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Flexible endoscopy for pediatric tracheobronchial metallic stent placement, maintenance and long-term outcomes

et al. 2018

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ObjectivesTo assess the placement, surveillance management and long-term outcomes of the tracheobronchial (TB) balloon expandable metallic stent (BEMS) managed by therapeutic flexible endoscopy (TFE).MethodsThis is a retrospective review and analysis of all computerized medical records and related flexible endoscopy videos of pediatric patients who received TB BEMS during 20 years period, from January 1997 to December 2016. TFE techniques with forceps debridement, balloon dilatation and laser ablation were used to implant stents, perform regular surveillance, maintain their functions, and expand the diameters of BEMS. Short-length (30cm-36cm) endoscopes of OD 3.2mm to 5.0mm coupled with the noninvasive ventilation, without ventilation bag, mask or airway tube, supported the whole procedures.Results146 BEMS were implanted in 87 consecutive children, including 84 tracheal, 15 carinal and 47 bronchial stents. At the time of placement, the mean age was 35.6 ± 54.6 month-old (range 0.3–228) and the mean body weight was 13.9 ± 10.6 kg (range 2.2–60). Surveillance period was 9.4 ± 6.7 years (range, 0.3–18.0). Satisfactory clinical improvements were noted immediately in all but two patients. Seventy-two (82.8%) patients were still alive with stable respiratory status, except two patients necessitating TFE management every two months. Fifty-one stents, including 35 tracheal and 16 bronchial ones, were successfully retrieved mainly with rigid endoscopy. Implanted stents could be significantly (< .001) further expanded for growing TB lumens. The final stent diameters were positively correlated to the implanted duration. Altogether, 33 stents expired (15 patients), 51 were retrieved (40 patients), and 62 remained and functioning well (38 patients), with their mean duration of 7.4 ± 9.5, 34.9 ± 36.3 and 82.3 ± 62.5 months, respectively.ConclusionIn pediatric patients, TFE with short-length scopes coupled with this NIV support has provided a safe, feasible and effective modality in placing and subsequently managing TB BEMS with acceptable long-term outcomes.

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“…However, the use of flexible bronchoscopy for the extraction of airway foreign bodies in children has been hampered by the small caliber of the suction channel and lack of appropriate instruments available to grasp the airway foreign bodies. [ 2 ] Even though many studies attempted to use various types of instruments, such as forceps or baskets, for extraction of foreign bodies in the airway,[ 2 9 10 11 12 13 ] the lack of standard equipment for foreign body removal in airway has been a hindrance.…”

Section: Discussionmentioning

confidence: 99%

Foreign body removal by flexible bronchoscopy using retrieval basket in children

et al. 2018

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OBJECTIVES:Aspiration of foreign bodies into the tracheobronchial tree is a common accident in children. This study aimed to evaluate the safety and outcome of foreign body removal by flexible bronchoscopy using a retrieval basket in children.METHODS:This was a retrospective study of children treated for foreign bodies in the airway via flexible bronchoscopy using a retrieval basket at a tertiary hospital in Korea between February 2014 and October 2017. The medical records of the patients were retrospectively reviewed and analyzed.RESULTS:A total of 20 children underwent foreign body removal from the airway via flexible bronchoscopy using a retrieval basket. The median age of the patients was 16 (range, 10–21.5) months, and 12 (60%) were male. Foreign bodies removed included 16 (80%) organic items including peanuts, almond, and beans, and 4 (20%) inorganic items including a plastic bag, metal screw, spring, and Lego brick. The locations of the foreign bodies included the central airway (n = 5; trachea, n = 4; subglottic area, n = 1), right bronchial tree (n = 9), and left bronchial tree (n = 6). Successful removal was observed in 18 (90%) cases. The only complication that occurred was mild laryngeal edema (n = 2) after the procedure; both improved with corticosteroid administration.CONCLUSION:Flexible bronchoscopic extraction of a foreign body in the airway using a retrieval basket in children can be performed successfully with minimal complications.

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Retrieval of tracheobronchial foreign bodies by short flexible endoscopy in children

Cited by 24 publications

References 21 publications

Therapeutic flexible airway endoscopy of small children in a tertiary referral center—11 years’ experience

Therapeutic flexible airway endoscopy of small children in a tertiary referral center—11 years’ experience

Flexible endoscopy for pediatric tracheobronchial metallic stent placement, maintenance and long-term outcomes

Foreign body removal by flexible bronchoscopy using retrieval basket in children

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