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Interventions in Pulmonary Medicine pp 185–207Cite as

Endobronchial Prosthesis

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Abstract

Airway stents have been consistently shown to help patients suffering from central airway obstruction and esophagorespiratory fistulas, by improving their quality of life and potentially survival. These prostheses, however, are foreign objects within the airways and adverse events are expected. The incidence rate of these events depends on patient-related factors and on specific stent–tissue interactions. Stent insertion is generally reserved for patients for whom curative open surgical interventions are not feasible or contraindicated. Metallic stents should be avoided in benign disease unless surgery or silicone stent placement is not possible. For malignant disease, stents are usually placed with a palliative intent and should be inserted to offer comfort without harming the terminally ill patient; therefore, they should be placed by operators who are able to manage both intraoperative, short-term and long-term complications after a careful analysis of expected benefits. Long-term stent-related complications are not uncommon and can occasionally be fatal. Since not all stents are equivalent in terms of biomechanics and stent–tissue interactions, manufacturers should probably describe these properties including the resistance to angulation, expansile force, and mechanical failure, not only to assure restoration of airway patency after insertion but also to potentially predict immediate and long-term stent-related complications.

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Notes

  1. 1.

    Central airway obstruction is defined in this chapter as any clinically significant narrowing of the airway from the subglottis to the lobar bronchi.

  2. 2.

    These include rigid or flexible bronchoscopic resection, laser, electrocautery, cryotherapy, photodynamic therapy, or brachytherapy and are described in detail in other chapters in this book.

  3. 3.

    Coexistent diseases: coronary heart disease, severe cardiac or respiratory insufficiency, or poor general condition.

  4. 4.

    Most studies define complex stenoses as follows: extensive scar ≥1 cm in vertical length, circumferential hourglass-like contraction scarring, or presence of associated malacia.

  5. 5.

    Granulation tissue formation at the proximal end of the T-tube has also been described, and it is believed that chronic airway irritation incites infection and promotes or aggravates granulation tissue formation.

  6. 6.

    In this study, patients with esophageal carcinoma ­involving the airway mostly required only stent placement without laser-assisted debulking, probably because the main problem was extrinsic compression.

  7. 7.

    An incidence proportion is defined as the number of cases with complications divided by the number of cases overall and is an appropriate measure for analyzing immediate perioperative complications [6].

  8. 8.

    It measures events per person-time at risk [6].

  9. 9.

    An electrical current in which the electron flow is in only one direction; galvanic currents cause fibroblast proliferation resulting in increase in collagen synthesis, property used for wound healing and also implicated in keloid formation.

  10. 10.

    Especially in patients with tumors who might have a nearly horizontal left main bronchus due to large subcarinal adenopathy.

  11. 11.

    In this regard, histologically benign CAO should be treated surgically or, for nonsurgical candidates, with silicone stents whenever possible.

  12. 12.

    Other conditions include experienced bronchoscopist and team, experienced anesthesiologist, control of patient’s overall performance status, additional systemic or local therapy still possible, and control of comorbidities.

  13. 13.

    One way to assess the perfusion status of lung parenchyma distal to an airway obstruction is to attempt bypassing the stenosis using a high-resolution EBUS radial probe.

Abbreviations

CAO:

Central airway obstruction

RRP:

Recurrent respiratory papillomatosis

EBUS:

Endobronchial ultrasound

SEMS:

Self-expandable metallic stents

6MWT:

Six-minute walk test

MRC:

Medical Research Council

BPF:

Bronchopleural fistula

ERF:

Esophagorespiratory fistulas

QOL:

Quality of life

ECAC:

Expiratory central airway collapse

EDAC:

Excessive dynamic airway collapse

TBM:

Tracheobronchomalacia

RP:

Relapsing polychondritis

CPAP:

Continuous positive airway pressure

EPP:

Equal pressure point

Ppl:

Pleural pressure

PL:

Intraluminal pressure

FLS:

Flow-limiting segment

TLC:

Total lung capacity

IOS:

Impulse oscillometry

R:

Resistance

Plat:

Lateral airway pressure

CT:

Computed tomography

ETT:

Endotracheal tube

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Authors and Affiliations

  1. Department of Medicine, University of Chicago, 5841 South Maryland Ave., MC 6076, Chicago, IL, 60637, USA

    Septimiu Dan Murgu M.D., F.C.C.P.

  2. Division of Pulmonary and Critical care Medicine, Orange, USA

    Septimiu Dan Murgu M.D., F.C.C.P.

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  1. Septimiu Dan Murgu M.D., F.C.C.P.
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Correspondence to Septimiu Dan Murgu M.D., F.C.C.P. .

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Editors and Affiliations

  1. MD Anderson Cancer Center, Houston, TX, Department of Pulmonary Medicine, Bellvitge University Hospital, Barcelona, 08907, Spain

    Jose Pablo Díaz-Jimenez

  2. Clinica Y Maternidad Colon, Pulmonary Department, Mar Del Plata, Buenos Aires, 7600, Argentina

    Alicia N. Rodriguez

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Murgu, S.D. (2013). Endobronchial Prosthesis. In: Díaz-Jimenez, J., Rodriguez, A. (eds) Interventions in Pulmonary Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6009-1_12

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