A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: Short- and long-term outcomes

Dutau, Hervé; Cavaillès, Arnaud; Sakr, Lama; Badier, M; Gaubert, Jean-Yves; Boniface, S.; Doddoli, Christophe; Thomas, Philippe; Reynaud‐Gaubert, Martine

doi:10.1016/j.healun.2009.12.011

Cited by 82 publications

(67 citation statements)

References 32 publications

(20 reference statements)

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“…FEV 1 and FVC improved following the intervention. Similar findings have been reported by others, including in patients with vasculitis- and tuberculosis-related airway stenosis [14,15,16,35]. …”

Section: Discussionsupporting

confidence: 91%

“…Therapeutic bronchoscopy is increasingly performed to alleviate CAO in patients with malignant and nonmalignant diseases alike, with several small retrospective studies showing improved outcomes with this approach [2,7,8,9,10,11,12,13,14,15,16,17]. However, there are few studies available that have systematically examined the impact of therapeutic bronchoscopy on pulmonary function, dyspnea, and quality of life (QOL) in patients with CAO [3,18,19,20].…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

et al. 2015

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Background: Central airway obstruction (CAO) occurs in patients with primary or metastatic lung malignancy and nonmalignant pulmonary disorders and results in significant adverse effects on respiratory function and quality of life. Objectives: The objective of this study was to assess the effect of therapeutic bronchoscopic interventions on spirometry, dyspnea, quality of life, and survival in patients with CAO. Methods: We prospectively studied patients who underwent therapeutic rigid bronchoscopy for CAO. Spirometry, San Diego Shortness of Breath questionnaire (SOBQ), and SF-36 questionnaire responses were obtained before the procedure and at follow-up 6-8 weeks after the procedure. Results: Fifty-three patients (24 malignant and 29 nonmalignant CAO), who underwent successful rigid bronchoscopic intervention, were enrolled. Airway stent placement and various debulking techniques including mechanical debridement and heat therapy were used. After bronchoscopy, there was a significant increase in forced vital capacity (2.2 ± 0.91 l before, 2.7 ± 0.80 l after, p = 0.009) and forced expiratory volume at 1 s (1.4 ± 0.60 l before, 1.8 ± 0.67 l after, p = 0.002). The SOBQ score improved from 55.8 ± 30.1 before the procedure to 37.9 ± 27.25 after the procedure (p = 0.002). In the SF-36, there was an improvement in almost all domains, with statistically significant improvement seen in several domains. Benefits were seen independent of the etiology of CAO, site of intervention or stent placement. The patients with malignant CAO, in whom airway patency could not be achieved, had a poor survival. Conclusions: Alleviation of CAO with therapeutic rigid bronchoscopy results in improvement in spirometry, shortness of breath, quality of life, and survival.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

et al. 2015

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“…During the 24-month observation period, lung function, expressed as FEV 1 , remained unchanged. These results confirm that our treatment strategy to use silicone stents whenever possible can be successful and support the findings of two papers recently published by Thistlethwaite et al [3] and Dutau et al [14], who also demonstrated excellent results after silicone stenting and subsequent removal. They reported patency of the airways after stent removal to be excellent in the majority of their patients, but spirometry data during follow-up were not presented.…”

Section: Discussionsupporting

confidence: 90%

Airway Complications after Lung Transplantation: Long-Term Outcome of Silicone Stenting

Sundset¹,

Lund²,

Hansen³

et al. 2012

Respiration

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Background: Airway complications remain a significant cause of morbidity after lung transplantation. The majority of the centres that have published their results have used metal stents. Objectives: We report the long-term outcome of silicone stenting and subsequent stent removal in lung transplant recipients with stenotic airway complications. Method: From 1990 to 2008, 279 patients received 88 single, 170 double, and 21 heart-and-lung transplantations. Of 470 anastomoses at risk, 44 airway complications developed and were treated in 35 patients. Six lesions were treated with Nd:YAG laser and balloon dilatations only. Thirty-two silicone stents of Hood or Dumont type were inserted in 27 patients. Results: Symptoms were relieved and FEV₁ increased in all patients (median 0.7 litres, range 0.1-1.8 litres, p < 0.0001). In 8 patients, stents had to be repositioned or reinserted, in 19 patients only one insertion and one removal procedure were necessary. One patient suffered a serious complication with haemorrhage and pneumonectomy, 3 patients had minor airway wall injuries resolving spontaneously. Six patients died with the stents from causes not related to the airway complications. Twenty-five stents could be removed after a median of 6 months (range 1-22) in 21 patients, and 22 airways remained patent. Median FEV₁ was 2.3 litres immediately after stent removal, and remained 2.3 litres after 24 months. Conclusion: Stenotic airway complications after lung transplantation can be successfully treated with silicone stents, which can ultimately be removed, leaving a patent airway.

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“…This is becoming a more common technique and is particularly important at transplant centers. Dutau et al showed in a single institution, retrospective study that the use of stents to treat lung transplant associated airway complications was both feasible and provided significant improvement in patient symptoms and outcomes (23). In our experience, we utilize adjunct treatments universally and have found no ill effects of such practice.…”

Section: Adjunctive Modalitiesmentioning

confidence: 63%

Current status of spray cryotherapy for airway disease

Moore¹,

Lile²,

Abbas³

2017

J. Thorac. Dis.

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The use of liquid nitrogen to treat skin and mucosal lesions is well understood in the dermatologic and gastrointestinal literature. Direct spray cryotherapy (SCT) in the airway has shown promising results in the treatment of esophageal premalignant and even invasive lesions. In the airway, several studies have shown it to be a safe, effective treatment for both benign and malignant disease. It is easily administered in the outpatient setting and can be repeated several times without undue side effects. In this article, we review the current literature on the use of SCT for the treatment of endobronchial lesions and also describe our own institutional experience of the use of SCT in the airway. The use of proper technique and airway venting is important in mitigating the complications of barotrauma from massive expansion of nitrogen upon conversion from the liquid to gaseous state. We also review some of the basic science principals behind the use of the cryotherapy to treat lesions in different tissues. We feel that SCT is a potential area for further research at both clinical and basic science level.

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A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: Short- and long-term outcomes

Cited by 82 publications

References 32 publications

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

Airway Complications after Lung Transplantation: Long-Term Outcome of Silicone Stenting

Current status of spray cryotherapy for airway disease

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