Removal of metallic stent by fiberoptic bronchoscopy in patients with benign airway stenosis

Abstract

Objective To evaluate the efficiency and safety of metallic stent removal by fiberoptic bronchoscopy in patients with benign airway stenosis. Methods The clinical data of 15 benign airway stenosis patients whose metallic stents were removed by fiberoptic bronchoscopy in the First Affiliated Hospital of Guangxi Medical University from August 2003 to December 2014 were retrospectively analyzed.The collected data included gender, age, etiology of airway stenosis, types of metallic stents and retention time, condition of metallic stents before and after removal, and related complications. Results (1)Among the 15 patients with benign airway stenosis, six were males, nine were females, and their age ranged from 18 to 70 years old, with an average of (35±14) years old.A total of 19 tracheobronchial stents were removed, including 11 covered metallic stents and eight uncovered metallic stents.The 19 tracheobronchial stents stayed in airway for a median of 2.4 months (0.6-3.6 months), and one tracheobronchial stent kept more than ten years.(2)Of the eight uncovered metallic stents, seven were embedded with hyperplastic granulation tissue which resulted in airway stenosis, two had stent fracture and one had stent displacement before stent retrieval.Of the 11 covered metallic stents, five were embedded with hyperplastic granulation tissue which resulted in airway stenosis, one had stent fracture and three had stent displacement before stent retrieval.(3) All 19 stents were successfully removed and the recovery rate was 100%.Complications included two cases (10.5%) of partial mucosal tear, one case (5.3%) of moderate hemorrhage, and one case (5.3%) of bronchial fistula.No death occurred during the procedure. Conclusions Removing metallic stent by fiberoptic bronchoscopy under local anesthesia is a safe and feasible method.When conducting the metallic stent removal, removing granulation tissue with thermal ablation first, following tracheal balloon dilatation, and then using biopsy forceps to determine a state of separation between stent and tracheal mucosa can significantly reduce the complications. Key words: Fiberoptic bronchoscopy; Benign airway stenosis; Stent removal; Safety