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

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          Abstract

          Background

          Self-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.

          Methods

          Data collected between January 2014 and July 2015 were retrospectively evaluated by reference to hospital records.

          Results

          The 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.

          Conclusion

          Endobronchial 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.

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          Most cited references 20

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          ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society.

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            Airway stabilization with silicone stents for treating adult tracheobronchomalacia: a prospective observational study.

            It is postulated that in patients with severe tracheobronchomalacia (TBM), airway stabilization with stents may relieve symptoms. To evaluate the effect of silicone stents (tracheal, mainstem bronchus, or both) on symptoms, quality of life, lung function, and exercise capacity in these patients. A prospective observational study in which baseline measurements were compared to those obtained 10 to 14 days after stent placement. Of 75 referred patients, 58 had severe disease and underwent therapeutic rigid bronchoscopy with stent placement. Mean age was 69 years (range, 39 to 91 years), 34 were men, 33 had COPD, and 13 had asthma. Almost all patients (n = 57) had dyspnea as a sole symptom or in combination with cough and recurrent infections; four patients required mechanical ventilation for respiratory failure. In 45 of 58 patients, there was reported symptomatic improvement; quality of life scores improved in 19 of 27 patients (p = 0.002); dyspnea scores improved in 22 of 24 patients (p = 0.001); functional status scores improved in 18 of 26 patients (p = 0.002); and mean exercise capacity improved from baseline, although not significantly. The 49 complications included mainly 21 partial stent obstructions, 14 infections, and 10 stent migrations. Most patients with concomitant COPD also improved on most measures. In the short term, airway stabilization with silicone stents in patients with severe TBM can improve respiratory symptoms, quality of life, and functional status. Coexisting COPD is not an absolute contraindication to a stenting trial in this population. Stenting is associated with a high number of short-term and long-term but generally reversible complications.
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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
                +902124090202 , cengizoz78@yahoo.com
                sinemtimur@yahoo.com
                leventkarasulu@gmail.com
                sedatural@yahoo.com
                leventdalar@gmail.com
                Journal
                Multidiscip Respir Med
                Multidiscip Respir Med
                Multidisciplinary Respiratory Medicine
                BioMed Central (London )
                1828-695X
                2049-6958
                30 April 2016
                30 April 2016
                2016
                : 11
                Affiliations
                [ ]Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey
                [ ]School of Medicine, Department of Pulmonary Medicine, Istanbul Bilim University, Istanbul, Turkey
                Article
                52
                10.1186/s40248-016-0052-5
                4851784
                27134746
                © Özdemir et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Original Research Article
                Custom metadata
                © The Author(s) 2016

                Respiratory medicine

                metallic stents, bronchoscopy, central airways

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