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Interventional bronchoscopy in the initial management of benign and malignant tracheal stenoses

Abstract

Introduction

Management of tracheal stenoses is inconsistent. Interventional bronchoscopy (IB) is one of the therapeutic options used.

Aim

The aim of the study was to investigate the role of IB in the initial management of tracheal stenosis, evaluating the treatment strategies used and complications encountered.

Patients and methods

We prospectively recruited 30 patients presenting with bronchoscopically confirmed tracheal stenoses over 1 year. Twenty benign (six simple and 14 complex) and 10 inoperable malignant tracheal stenoses were studied. All except two patients underwent rigid IB with different modalities. Each patient was followed up for 6 months.

Results

All simple, 12 complex (not eligible for surgery), and all malignant stenoses were treated with 17 (mean of 2.83 per patient), 52 (mean of 4.33 per patient), and 39 (mean of 2.83 per patient) IB procedures, respectively, including 1, 10, and 8 stent placements, respectively, with overall good therapeutic response after IB. Two patients with complex stenoses were sent for surgery. During the first 6 months after stent insertion, stent migration occurred in 27 and 12% and obstruction by mucus secretions occurred in 64 and 37% of benign and malignant stenoses, respectively. Granuloma formation occurred in 45% of benign stenoses. Tumor in-growth occurred in 37% of malignant stenoses. All complications were non-life-threatening stent-related complications that were easily managed. During follow-up, two malignant patients died of disease progression.

Conclusion

IB is a useful option in the management of simple benign and inoperable complex benign and malignant tracheal stenoses associated with a relatively high rate of non-life-threatening stent-related complications that were easily managed.

References

  1. Puchalski J. Tracheal and bronchial stenosis: etiologies, bronchoscopic interventions and outcomes. Pak J Chest Med 2012; 18:38–46.

    Google Scholar 

  2. Galluccio G, Lucantoni G, Battistoni P, Paone G, Batzella S, Lucifora V, Dello Iacono R. Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long-term follow-up. Eur J Cardiothorac Surg 2009; 35:429–433; discussion 933–934.

    Article  Google Scholar 

  3. Mostafa B, Chaouch-Mbarek C, Halafawi A. Tracheal stenosis: diagnosis and management; 2012. Available at: http://www.telemed.shams.edu.eg/moodle/pluginfile.php. [Accessed 2 October 2013].

  4. Ghorbani A, Dezfouli AA, Shadmehr MB, Pejhan S, Saghebi SR, Ghare-Daghi AS, et al. A proposed grading system for post-intubation tracheal stenosis. Tanaffos 2012; 11:10–14.

    PubMed  PubMed Central  Google Scholar 

  5. Fernando HC, Sherwood JT, Krimsky W. Endoscopic therapies and stents for benign airway disorders: where are we, and where are we heading? Ann Thorac Surg 2010; 89:2183–2187.

    Article  Google Scholar 

  6. Macchiarini P, Verhoye JP, Chapelier A, Fadel E, Dartevelle P. Partial cricoidectomy with primary thyrotracheal anastomosis for postintubation subglottic stenosis. J Thorac Cardiovasc Surg 2001; 121:68–76.

    Article  CAS  Google Scholar 

  7. Wright CD, Grillo HC, Wain JC, Wong DR, Donahue DM, Gaissert HA, Mathisen DJ. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg 2004; 128:731–739.

    Article  Google Scholar 

  8. Ciccone AM, De Giacomo T, Venuta F, Ibrahim M, Diso D, Coloni GF, Rendina EA. Operative and non-operative treatment of benign subglottic laryngotracheal stenosis. Eur J Cardiothorac Surg 2004; 26:818–822.

    Article  Google Scholar 

  9. Lee KH, Ko GY, Song HY, Shim TS, Kim WS. Benign tracheobronchial stenoses: long-term clinical experience with balloon dilation. J Vasc Interv Radiol 2002; 13(Pt 1):909–914.

    Article  Google Scholar 

  10. Bolliger CT, Sutedja TG, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J 2006; 27:1258–1271.

    Article  CAS  Google Scholar 

  11. Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH. A proposed classification system of central airway stenosis. Eur Respir J 2007; 30:7–12.

    Article  CAS  Google Scholar 

  12. Eisenhauer E, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumors: revised RECIST guideline. Eur J Cancer 2009; 45:228–247.

    Article  CAS  Google Scholar 

  13. Lorx A, Valko L, Penzes I. Anaesthesia for interventional bronchoscopy. Eur Respir Mon 2010; 48:18–32.

    Google Scholar 

  14. Mehta AC, Lee FY, Cordasco EM, Kirby T, Eliachar I, De Boer G. Concentric tracheal and subglottic stenosis. Management using the Nd-YAG laser for mucosal sparing followed by gentle dilatation. Chest 1993; 104:673–677.

    CAS  PubMed  Google Scholar 

  15. Korraa E, Madkour A, Todary A, et al. Evaluation of bronchoscopic placement of tracheobronchial silicone stents: an Ain Shams University Hospital experience. Egypt J Bronchol 2014; 8:38–43.

    Article  Google Scholar 

  16. Wong JL, Tie ST, Samril B, Lum CL, Rahman MR, Rahman JA. Successful treatment of tracheal stenosis by rigid bronchoscopy and topical mitomycin C: a case report. Cases J 2010; 3::2. Available at: http://www.casesjournal.com/content/3/1/2. [Accessed 2 October 2013].

    Article  Google Scholar 

  17. Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995; 109:486–492.

    Article  CAS  Google Scholar 

  18. Rea F, Callegaro D, Loy M, Zuin A, Narne S, Gobbi T, et al. Benign tracheal and laryngotracheal stenosis: surgical treatment and results. Eur J Cardiothorac Surg 2002; 22:352–356.

    Article  Google Scholar 

  19. Cavaliere S, Dumon J. Laser bronchoscopy. In: Bolliger C, Mathur, P, editors. Interventional bronchoscopy. Progress in respiratory research. Basel: Karger; 2000. 30:108–119.

    Google Scholar 

  20. Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis 2014; 6:258–270.

    PubMed  PubMed Central  Google Scholar 

  21. Brichet A, Verkindre C, Dupont J, Carlier ML, Darras J, Wurtz A, et al. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J 1999; 13:888–893.

    Article  CAS  Google Scholar 

  22. Marel M, Pekarek Z, Spasova I, Pafko P, Schutzner J, Betka J, Pospisil R. Management of benign stenoses of the large airways in the university hospital in Prague, Czech Republic, in 1998–2003. Respiration 2005; 72:622–628.

    Article  Google Scholar 

  23. Cosano Povedano A, Muñoz Cabrera L, Cosano Povedano F, Rubio Sánchez F, Pascual Martínez F, Escribano Dueñas F, et al. Endoscopic treatment of central airway stenosis: five years’ experience. Arch Bronconeumol 2005; 41:322–327.

    Article  CAS  Google Scholar 

  24. Martinez-Ballarin JI, Diaz-Jimenez JP, Castro MJ, Moya JA. Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients. Chest 1996; 109:626–629.

    CAS  PubMed  Google Scholar 

  25. Puchalski J, Musani AI. Tracheobronchial stenosis: causes and advances in management. Clin Chest Med 34:2013:557–567.

    Article  Google Scholar 

  26. Kim HJ, Kim SW, Lee HY, Kang HH, Kang JY, Kim JS, et al. Clinical experience of rigid bronchoscopy in single center. Tuberc Respir Dis (Seoul) 2012; 72:486–492.

    Article  Google Scholar 

  27. Gaafar AH, Shaaban AY, Elhadidi MS. The use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction. Eur Arch Otorhinolaryngol 2012; 269:247–253.

    Article  Google Scholar 

  28. Adrian PC. Possibilities and limits of interventional bronchoscopy in malignant tracheal stenosis [MD thesis]; 2014, Craiova, Romania.

  29. Chhajed PN, Somandin S, Baty F, Mehta AJ, Azzola A, Leuppi J, et al. Therapeutic bronchoscopy for malignant airway stenoses: choice of modality and survival. J Cancer Res Ther 2010; 6:204–209.

    Article  Google Scholar 

  30. Su JM, Wu TC, Wu MF, Chang H, Chou MC. Management of malignant tracheobronchial stenoses with the use of airway stents. J Chin Med Assoc 2004; 67:458–464.

    PubMed  Google Scholar 

  31. Noppen M, Poppe K, D’Haese J. Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease. Chest 2004; 125:723–730.

    Article  Google Scholar 

  32. Noppen M, Meysman M, Dhondt E, Gepts L, Velkeniers B, Vanhaelst L, Vincken W. Upper airway obstruction due to inoperable intrathoracic goitre treated by tracheal endoprosthesis. Thorax 1994; 49:1034–1036.

    Article  CAS  Google Scholar 

  33. Wood DE, Liu YH, Vallières E, Karmy-Jones R, Mulligan MS. Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg 2003; 76:167–172; discussion 173–174.

    Article  Google Scholar 

  34. Dumon J, Cavaliere S, Diaz-Jimenez P, et al. Seven year experience with the Dumon prosthesis. J Bronchol 1996; 3:6–10.

    Article  Google Scholar 

  35. Noppen M, Meysman M, Claes I, D’Haese J, Vincken W. Screw-thread vs Dumon endoprosthesis in the management of tracheal stenosis. Chest 1999; 115:532–535.

    Article  CAS  Google Scholar 

  36. Murgu SD, Colt HG. Complications of silicone stent insertion in patients with expiratory central airway collapse. Ann Thorac Surg 2007; 84:1870–1877.

    Article  Google Scholar 

  37. Vergnon J, Costes F, Polio J. Efficacy and tolerance of anew silicone stent for the treatment of benign tracheal stenosis: preliminary results. Chest 2000; 118:422–426.

    Article  CAS  Google Scholar 

  38. Miwa K, Takamori S, Hayashi A, Fukunaga M, Shirouzu K. Fixation of silicone stents in the subglottic trachea: preventing stent migration using a fixation apparatus. Ann Thorac Surg 2004; 78:2188–2190.

    Article  Google Scholar 

  39. Colt HG, Harrell J, Neuman TR, Robbins T. External fixation of subglottic tracheal stents. Chest 1994; 105:1653–1657.

    Article  CAS  Google Scholar 

  40. Chin CS, Litle V, Yun J, Weiser T, Swanson SJ. Airway stents. Ann Thorac Surg 2008; 85:S792–S796.

    Article  Google Scholar 

  41. Hoppe H, Dinkel HP, Walder B, von Allmen G, Gugger M, Vock P. Grading airway stenosis down to the segmental level using virtual bronchoscopy. Chest 2004; 125:704–711.

    Article  Google Scholar 

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Correspondence to Ashraf Madkour MD.

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Madkour, A., Elmansoury, A. & Elsharkawy, S. Interventional bronchoscopy in the initial management of benign and malignant tracheal stenoses. Egypt J Bronchol 9, 146–153 (2015). https://doi.org/10.4103/1687-8426.158049

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