Clinical Outcomes of Complications Following Self-Expandable Metallic Stent Insertion for Benign Tracheobronchial Stenosis.

Byeong-Ho Jeong,Jeffrey Ng,Suk Hyeon Jeong,Hojoong Kim

doi:10.3390/medicina56080367

Abstract

Background and Objectives: The use of metallic stents in benign TBS is controversial. Here, we report the clinical outcomes of patients who developed complications due to self-expandable metallic stent (SEMS) insertion for benign TBS. Materials and Methods: Our institution, which is the largest and most active referral hospital for airway stenosis in South Korea, only uses silicone stents. We conducted a retrospective review of 20 patients referred after the insertion of SEMS for benign TBS from 2006 to 2015. Results: All 20 patients underwent rigid bronchoscopy for SEMS removal due to airway obstruction from granulation tissue overgrowth. All but one (95%) experienced successful removal of the SEMS. During a median follow-up period of 40 months, a median of seven rigid bronchoscopies per patient was needed to maintain airway patency. Three (15%) patients suffered acute complications during SEMS removal (bleeding (10%) and fistula (5%)). All patients suffered chronic complications (granulation tissue (80%), stent migration (58%), mucostasis (55%), and restenosis (43%)). Eventually, 15 patients (75%) needed airway prostheses (silicone stent (75%) and tracheostomy (25%)). Conclusion: Our findings indicate that SEMS should be avoided until positive results are consistently reported by high-quality studies in patients with benign TBS.

Highlights

The majority of benign tracheobronchial stenosis (TBS) cases can be managed less invasively with interventional bronchoscopy rather than open surgery [1,2]
The popularity of silicone stents has declined with the rise in the flexible bronchoscopy and recent expert opinion advocating the use of self-expandable metallic stents (SEMS) in selected cases, despite a lack of substantiating evidence [9,10]
The etiology of benign TBS consisted of post-tuberculous tracheobronchial stenosis (PTBS; n = 7), post-intubation tracheal stenosis (PITS; n = 5), post-tracheostomy tracheal stenosis (PTTS; n = 5), post-operative tracheal stenosis (POTS; n = 1), traumatic bronchial rupture (n = 1), and tracheomalacia (n = 1)

Summary

Introduction

The majority of benign tracheobronchial stenosis (TBS) cases can be managed less invasively with interventional bronchoscopy rather than open surgery [1,2]. In 1987, Dumon developed a dedicated tracheobronchial silicone stent with multiple external studs that can be inserted and removed with rigid bronchoscopy [3]. The use of metallic stents in benign TBS is controversial. We report the clinical outcomes of patients who developed complications due to self-expandable metallic stent (SEMS) insertion for benign TBS. We conducted a retrospective review of 20 patients referred after the insertion of SEMS for benign TBS from 2006 to 2015. Results: All 20 patients underwent rigid bronchoscopy for SEMS removal due to airway obstruction from granulation tissue overgrowth. During a median follow-up period of 40 months, a median of seven rigid bronchoscopies per patient was needed to maintain airway patency. Three (15%) patients suffered acute complications during SEMS removal (bleeding (10%) and fistula (5%)).

Results

Discussion

Conclusion