Removal Of Metallic Stent By Bronchoscopy In Patients With Benign Center Airway Stenosis

Objective:To evaluate the management, efficiency and safety of metallic stents removal via the bronchoscopy in patients with benign airway stenosis.Methods:We retrospectively analyzed the clinical data 15 cases with benign center airway stenosis in the first affiliated hospital of Guangxi Medical University between August 2003 and December 2014, whose metallic stents were removed under the guidance of the bronchoscopy. The collected data include the gender, the reason for airway stenosis, the type of metallic stent and its retention time, the metallic stent’s condition before and after removal, and the related complication.Results:(1) A total of 6 males,9 females, aged 18-70 y (35±14) of benign airway stenosis were included in the analysis. A total of 19 tracheobronchial stents placements were conducted, including 11 covered metallic stents (CMS) and 8 uncovered metallic stents (UCMS). The 19 tracheobronchial were removed with an median time 2.4 months (inter-quartile range,0.6-3.6 months), and 1 of which was indwelt more than 10 years.(2)Of the 8 UCMS,7 embedded with hyperplastic granulation tissue and resultant airway stenosis,2 with stent fracture and 1 with stent displacement were observed before stents retrieval. Of the 11 CMS,5 embedded with hyperplastic granulation tissue and resultant airway stenosis,1 with stent fracture and 3 with stent displacement were observed.(3)19 stents were all removed successfully under local anesthesia combined with intravenous drugs based anesthesia. In all cases,4 patients were suffered from post-removal complications including mucosal tear (n=2,10.5%), moderate hemorrhage (n=1,5.3%), and bronchial fistula (n=1,5.3%). No death occurred during the procedure.Conclusions:The management of removing the metallic stent with local anesthesia by bronchoscopy is safe and feasible. The complications were especially significantly reduced when conducted as the following process. Remove granulation tissue with thermal ablation, performed tracheal balloon dilatation, and then use biopsy forceps to determine a state of separation between net and tracheal mucosa.