Do airway metallic stents for benign lesions confer too costly a benefitReport as inadecuate




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BMC Pulmonary Medicine

, 8:7

First Online: 18 April 2008Received: 11 December 2007Accepted: 18 April 2008

Abstract

BackgroundThe use of self-expanding metallic stents SEMAS in the treatment benign airway obstruction is controversial.

MethodsTo evaluate the safety and efficacy of SEMAS for this indication, we conducted a 10-year retrospective review at our tertiary medical centre.

ResultsUsing flexible bronchoscopy, 82 SEMAS 67% Ultraflex, 33% Wallstent were placed in 35 patients with inoperable lesions, many with significant medical comorbidities 88%. 68% of stents were tracheal, and 83% of patients showed immediate symptomatic improvement. Reversible complications developed in 9% of patients within 24 hrs of stent placement. Late complications >24 hrs occurred in 77% of patients, of which 37% were clinically significant or required an interventional procedure. These were mainly due to stent migration 12.2%, fracture 19.5%, or obstructive granulomas 24.4%. The overall granuloma rate of 57% was higher at tracheal sites 59% than bronchial ones 34%, but not significantly different between Ultraflex and Wallstents. Nevertheless, Wallstents were associated with higher rates of bleeding 5% vs. 30%, p = 0.005 and migration 7% vs. 26%, p = 0.026. Of 10 SEMAS removed using flexible bronchoscopy, only one was associated with incomplete removal of fractured stent wire. Median survival was 3.6 ± 2.7 years.

ConclusionIll patients with inoperable lesions may be considered for treatment with SEMAS.

AbbreviationsFDAFood and Drug Administration

SEMASself-expandable metallic stent

FBflexible bronchoscopy

RBrigid bronchoscopy

CPAPcontinuous positive airway pressure

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2466-8-7 contains supplementary material, which is available to authorized users.

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Author: Andrew L Chan - Maya M Juarez - Roblee P Allen - Timothy E Albertson

Source: https://link.springer.com/







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