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      Current treatment of tracheoesophageal fistula

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          Abstract

          Tracheoesophageal fistulas (TEFs) often occur with esophageal or bronchial carcinoma. Currently, we rely on implantation of delicate devices, such as self-expanding and silicone stents, in the esophagus or trachea to cover the fistula and expand the stenosis in order to relieve patient pain. However, because each case is different, our approach may not be effective for every patient. Consequently, new devices and technology have emerged to address these situations, such as degradable stents, Amplatzer ® devices, endobronchial one-way umbrella-shaped valves, and transplantation of mesenchymal stem cells. Although some studies have shown such alternatives can be reasonable solutions in special cases, further development of other new and effectual techniques is of utmost importance.

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          Most cited references35

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          A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences.

          We report on 11 patients with gastric or colonic bleeding or lesions who were treated with a new endoscopic over-the-scope clip (OTSC) system. The aim of this retrospective analysis was the evaluation of the clinical outcome and description of the new endoscopic device. The data of the patients were evaluated retrospectively. The OTSC system is composed of an application cap, which is mounted onto the distal tip of the endoscope and a connected releasing mechanism, installed on the handle of the scope. Two different variants of the clip, consisting of a shape-memory alloy (nitinol) are available: the "traumatic" and the "atraumatic" versions. In contrast to common endoscopic clips, the OTSC is able to compress larger quantities of tissue. We treated 11 patients (range, 51-84 years; 8 men, 3 women) with severe bleeding or deep wall lesions, or perforations of the GI tract. All treatments were primarily successful, hemostasis was achieved, and lesions could be closed. We reexamined the patients after the intervention and did not see any complications that could be ascribed to the clip itself or to the applicator cap. The OTSC system is a new tool for the endoscopic compression of tissue. Indications for its use are difficult nonvaricose bleedings and lesions or perforations of the GI tract.
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            A proposed classification system of central airway stenosis.

            Tracheobronchial stenosis, a serious problem in adults and children, has multiple causes and has been treated in many ways. While developing an international multicentre study to evaluate efficacy of airway stents, it was realised that no adequate description of central airway stenosis regarding type, location and degree has been published. Thus, comparing results of different treatment modalities in different centres has been difficult due to a lack of uniformity of classification. Reports are typically descriptive and precise classification schemes have not adequately addressed either for the trachea or the main bronchi. A standardised classification scheme was proposed with descriptive images and diagrams for rapid and uniform classification of central airway stenosis. The present authors' system divides stenosis into structural and dynamic types and further classifies the disease by degree of stenosis, location and transition zone. Multiple sites can be described and each is transformed into a simple numerical scoring system prompted by a diagram, which can be easily captured for subsequent uniform analysis across sites. A pilot validation of the system, with 18 pulmonologists of varying training background, showed strong precision and agreement between observers. Such a system will enhance the ability to study the effectiveness of treatment modalities for central airway stenosis.
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              A dedicated tracheobronchial stent.

              J-C Dumon (1990)
              A dedicated tracheobronchial stent to be used in the treatment of external compression of the main airway is described. This stent is made of molded silicone. Its outside surface bears regularly placed studs to prevent displacement. First results are encouraging. So far, 118 prostheses have been placed in 66 patients. Tolerance was excellent and complications were rare. Migration occurred 12 times: in seven cases an early prototype that was poorly designed had been used. Obstruction was noted in two cases without major problems. Mean follow-up at the time of this writing is three months, with the longest follow-up 19 months.
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                Author and article information

                Contributors
                Journal
                Ther Adv Respir Dis
                Ther Adv Respir Dis
                TAR
                sptar
                Therapeutic Advances in Respiratory Disease
                SAGE Publications (Sage UK: London, England )
                1753-4658
                1753-4666
                13 February 2017
                April 2017
                : 11
                : 4
                : 173-180
                Affiliations
                [1-1753465816687518]Department of Respiratory, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                [2-1753465816687518]Department of Respiratory, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Shengli Street No. 26, Wuhan 430014, China
                [3-1753465816687518]Department of Respiratory, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                [4-1753465816687518]Department of Respiratory, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                Author notes
                Article
                10.1177_1753465816687518
                10.1177/1753465816687518
                5933624
                28391759
                bcc4105d-5cde-43ad-8ecc-c529bee7c8ec
                © The Author(s), 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 13 July 2016
                : 29 November 2016
                Categories
                Reviews

                covered self-expanding stents,silicone stents,tracheoesophageal fistula

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