Endoscopic removal of metallic airway stents

William Lunn, David Feller-Kopman, Momen Wahidi, Simon Ashiku, Robert Thurer, Armin Ernst

Research output: Contribution to journalArticle

Abstract

Background: Complications of metallic airway stents include granulation tissue formation, fracture of struts, migration, and mucous plugging. When these complications result in airway injury or obstruction, it may become necessary to remove the stent. There have been few reports detailing techniques and complications associated with endoscopic removal of metallic airway stents. We report our experience with endoscopic removal of 30 such stents over a 3-year period. Methods: We conducted a retrospective review of 25 patients who underwent endoscopic stent removal from March 2001 to April 2004. The patients ranged in age from 17 to 80 years (mean, 56.3 years). There were 10 male and 15 female patients. The stents had been placed for nonmalignant disease in 20 patients (80%) and malignant disease in 5 patients (20%). All procedures were done under general anesthesia with a rigid bronchoscope. Special attention was focused on the technique of stent removal and postoperative complications. Results: Thirty metallic airway stents were successfully removed from 25 consecutive patients over a 3-year period. The basic method of removal involved the steady application of traction to the stent with alligator forceps. In all cases, an instrument such as the barrel of the rigid bronchoscope or a Jackson dilator was employed to help separate the stent from the airway wall before removal was attempted. In some instances, the airway wall was pretreated with thermal energy prior to stent removal. Complications were as follows: retained stent pieces (n = 7), mucosal tear with bleeding (n = 4), reobstruction requiring temporary silicone stent placement (n = 14), need for postoperative mechanical ventilation (n = 6), and tension pneumothorax (n = 1). Conclusions: Although metallic stents may be safely removed endoscopically, complications are common and must be anticipated. Other investigators have described airway obstruction and death as a result of attempted stent removal. Placement and removal of metallic airway stents should only be performed at centers that are prepared to deal with the potentially life-threatening complications.

Original languageEnglish (US)
Pages (from-to)2106-2112
Number of pages7
JournalChest
Volume127
Issue number6
DOIs
StatePublished - Jun 2005
Externally publishedYes

Fingerprint

Stents
Bronchoscopes
Alligators and Crocodiles
Granulation Tissue
Traction
Silicones
Pneumothorax
Airway Obstruction
Tears
Artificial Respiration
Surgical Instruments
General Anesthesia
Hot Temperature
Research Personnel

Keywords

  • Airway
  • Airway injury
  • Bronchoscopy
  • Complications
  • Respiratory failure
  • Stenosis
  • Stent

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Lunn, W., Feller-Kopman, D., Wahidi, M., Ashiku, S., Thurer, R., & Ernst, A. (2005). Endoscopic removal of metallic airway stents. Chest, 127(6), 2106-2112. https://doi.org/10.1378/chest.127.6.2106

Endoscopic removal of metallic airway stents. / Lunn, William; Feller-Kopman, David; Wahidi, Momen; Ashiku, Simon; Thurer, Robert; Ernst, Armin.

In: Chest, Vol. 127, No. 6, 06.2005, p. 2106-2112.

Research output: Contribution to journalArticle

Lunn, W, Feller-Kopman, D, Wahidi, M, Ashiku, S, Thurer, R & Ernst, A 2005, 'Endoscopic removal of metallic airway stents', Chest, vol. 127, no. 6, pp. 2106-2112. https://doi.org/10.1378/chest.127.6.2106
Lunn W, Feller-Kopman D, Wahidi M, Ashiku S, Thurer R, Ernst A. Endoscopic removal of metallic airway stents. Chest. 2005 Jun;127(6):2106-2112. https://doi.org/10.1378/chest.127.6.2106
Lunn, William ; Feller-Kopman, David ; Wahidi, Momen ; Ashiku, Simon ; Thurer, Robert ; Ernst, Armin. / Endoscopic removal of metallic airway stents. In: Chest. 2005 ; Vol. 127, No. 6. pp. 2106-2112.
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title = "Endoscopic removal of metallic airway stents",
abstract = "Background: Complications of metallic airway stents include granulation tissue formation, fracture of struts, migration, and mucous plugging. When these complications result in airway injury or obstruction, it may become necessary to remove the stent. There have been few reports detailing techniques and complications associated with endoscopic removal of metallic airway stents. We report our experience with endoscopic removal of 30 such stents over a 3-year period. Methods: We conducted a retrospective review of 25 patients who underwent endoscopic stent removal from March 2001 to April 2004. The patients ranged in age from 17 to 80 years (mean, 56.3 years). There were 10 male and 15 female patients. The stents had been placed for nonmalignant disease in 20 patients (80{\%}) and malignant disease in 5 patients (20{\%}). All procedures were done under general anesthesia with a rigid bronchoscope. Special attention was focused on the technique of stent removal and postoperative complications. Results: Thirty metallic airway stents were successfully removed from 25 consecutive patients over a 3-year period. The basic method of removal involved the steady application of traction to the stent with alligator forceps. In all cases, an instrument such as the barrel of the rigid bronchoscope or a Jackson dilator was employed to help separate the stent from the airway wall before removal was attempted. In some instances, the airway wall was pretreated with thermal energy prior to stent removal. Complications were as follows: retained stent pieces (n = 7), mucosal tear with bleeding (n = 4), reobstruction requiring temporary silicone stent placement (n = 14), need for postoperative mechanical ventilation (n = 6), and tension pneumothorax (n = 1). Conclusions: Although metallic stents may be safely removed endoscopically, complications are common and must be anticipated. Other investigators have described airway obstruction and death as a result of attempted stent removal. Placement and removal of metallic airway stents should only be performed at centers that are prepared to deal with the potentially life-threatening complications.",
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AB - Background: Complications of metallic airway stents include granulation tissue formation, fracture of struts, migration, and mucous plugging. When these complications result in airway injury or obstruction, it may become necessary to remove the stent. There have been few reports detailing techniques and complications associated with endoscopic removal of metallic airway stents. We report our experience with endoscopic removal of 30 such stents over a 3-year period. Methods: We conducted a retrospective review of 25 patients who underwent endoscopic stent removal from March 2001 to April 2004. The patients ranged in age from 17 to 80 years (mean, 56.3 years). There were 10 male and 15 female patients. The stents had been placed for nonmalignant disease in 20 patients (80%) and malignant disease in 5 patients (20%). All procedures were done under general anesthesia with a rigid bronchoscope. Special attention was focused on the technique of stent removal and postoperative complications. Results: Thirty metallic airway stents were successfully removed from 25 consecutive patients over a 3-year period. The basic method of removal involved the steady application of traction to the stent with alligator forceps. In all cases, an instrument such as the barrel of the rigid bronchoscope or a Jackson dilator was employed to help separate the stent from the airway wall before removal was attempted. In some instances, the airway wall was pretreated with thermal energy prior to stent removal. Complications were as follows: retained stent pieces (n = 7), mucosal tear with bleeding (n = 4), reobstruction requiring temporary silicone stent placement (n = 14), need for postoperative mechanical ventilation (n = 6), and tension pneumothorax (n = 1). Conclusions: Although metallic stents may be safely removed endoscopically, complications are common and must be anticipated. Other investigators have described airway obstruction and death as a result of attempted stent removal. Placement and removal of metallic airway stents should only be performed at centers that are prepared to deal with the potentially life-threatening complications.

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KW - Respiratory failure

KW - Stenosis

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