Abstract
BackgroundSelf-expandable metallic stents (SEMSs) have enabled a approving management of malignant airway stenosis. However, the long-term efficacy and safety of this treatment in patients with benign airway stricture are unclear. We conducted this study to retrospectively determine the efficacy and long-term outcomes in patients who have undergone SEMS placement for benign tracheobronchial stenosis.MethodsAll patients treated with SEMSs from July 2003 to June 2016 were reviewed for symptomatic response, complications, and long-term outcomes.ResultsTotal 131 stents were successfully deployed in 116 patients. Ninety-eight patients demonstrated clinical improvement after stent insertion (84.48%; 95% confidence interval [CI]: 77.89–91.07). Compared with uncovered stents, covered stents were associated with more sore throats complaints or chest pain (13.89% versus 28.81%, P = 0.036) and with higher incidences of major and minor granulation tissue formation and with recurrent stenosis (4.17% versus 15.25%, P = 0.029; 11.11% versus 37.29%, P < 0.0001 and 9.72% versus 28.81%, P = 0.005, respectively). Each covered and uncovered stent developing tissue hyperplasia required a median of 2 (range: 1–15) and 1(range: 1–7) fibrobronchoscope with electrocautery therapy, respectively. At follow-up (median: 1276 days; range: 2–4263), 68 patients had complete resolution, 15 remained under interventional treatment, 8 had bronchial occlusions, 7 underwent surgery, 14 were lost to follow-up, and 4 died of stent unrelated causes.ConclusionSEMS placement achieved most clinical improvement among patients in our study, if adequate endotracheal measures were used to address stent-related complications. The use of permanent SEMSs for benign tracheobronchial stenosis was effective and safe for the majority of patients in a long-term follow-up.Trial registrationThe study has been retrospectively registered in the China Clinical Trial Registry on October 21, 2018 (Registry ID: ChiCTR1800019024).
Highlights
Self-expandable metallic stents (SEMSs) have enabled a approving management of malignant airway stenosis
Design This research was a retrospective study. It identified all patients with benign tracheal stenosis who underwent self-expandable metallic stents (SEMSs) placement from July 2003 to June 2016 at the Respiratory and Critical Care Medicine Unit of West China Hospital (Chengdu, China)
Population The study identified 116 patients (57 men and 59 women; age range: 17–74 years; mean age: 38.96 years) affected by benign tracheal stenosis resulting from tuberculosis (n = 55), percutaneous dilation tracheotomy (n = 37), endotracheal tube (n = 16), postbronchial repair (n = 3), relapsing polychondritis (n = 2), fungal infection (n = 1), tracheoesophageal fistula repair (n = 1), and mediastinal cyst (n = 1)
Summary
Self-expandable metallic stents (SEMSs) have enabled a approving management of malignant airway stenosis. We conducted this study to retrospectively determine the efficacy and long-term outcomes in patients who have undergone SEMS placement for benign tracheobronchial stenosis. Some interventional pulmonologists have used SEMSs in benign tracheal stenosis, and there is still controversy with respect to the long-term patency and complications of this therapy. Due to the lack of comprehensive observations on the efficacy and long-term outcomes this treatment remains controversial This procedure has been performed at our institution for nearly 13 years in a variety of benign tracheal stenosis procedures, and approximately 10 years of follow-up data are available. The purpose of this study was to retrospectively determine the efficacy and long-term outcomes in patients who have undergone tracheobronchial metal stent placement for benign diseases
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