Abstract
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.
Highlights
Tracheobronchial (TB) narrowing in children, either congenital or acquired, that compromise breathing flow may produce significant respiratory distress and even fatal consequences
Most reported pediatric studies have been small in size and rarely given in detail on the metallic stent placement, maintenance, retrieval, and long-term outcomes [6,7,8,9,10]
We have found that these balloon expandable metallic stent (BEMS) could be accurately placed and well managed to maintain TB lumen patency with therapeutic flexible endoscopy (TFE)
Summary
Tracheobronchial (TB) narrowing in children, either congenital or acquired, that compromise breathing flow may produce significant respiratory distress and even fatal consequences. Victims who failed the medical management need to receive more invasive surgical procedures such as tracheostomy, tracheoplasty, thoracotomy, bronchoplasty and/or extracorporeal life support (ECLS). TB stents can be used to provide intraluminal structural support in order to maintain patency of the airways. Metallic stent placement has been introduced as an attractive option in children since 1990s, which can provide immediate, durable and stable TB lumen patency and improving quality of life [1,2,3,4,5]. Since stents are foreign bodies, they do have complications and associated technical problems, especially in pediatric patients. Most reported pediatric studies have been small in size and rarely given in detail on the metallic stent placement, maintenance, retrieval, and long-term outcomes [6,7,8,9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
