Endobronchial treatment in the airway obstruction – 100 cases

Author: Ricardo Isoro

Head of Bronchoscopy service. Enrique Tornú Hospital. Buenos Aires. Argentina

Introduction

Tracheobronchial unclogging is a method to permeabilize the airway and offer a better quality of life for the patient. As of 1997, the bronchoscopy service of the Enrique Tornú Hospital performs the first endo-surgical treatments of the tracheal and bronchial lumen, with the use of stents, occlusive and sub occlusive lesions of benign or malignant nature, trachea and/or bronchi were treated in 100 patients. All of them have been members of the surgery.

The airway clearance procedures were carried out with:

  1. High frequency electrosurgical device
  2. Mechanical dilatation
  3. Prosthetic implant

Indications

Neoplastic conditions or their consequences

  • Tracheobronchial neoplasms
  • Extrinsic compression or compromise of the submucosa
  • After laser photorecorder, cryotherapy or electrocautery, to maintain the opening of the airway
  • Tracheobronchoesophageal fistula (in conjunction with esophageal stent)

Benign conditions

  • Secondary bronchial stenosis to terminal-terminal anastomosis or pulmonary transplantation
  • Post-traumatic (post-intubation)
  • Post-infectious (endobronchial tuberculosis, histoplasmosis with mediastinal fibrosis, herpes virus, diphtheria, opportunistic infections in immunocompromised patients)
  • Tracheobronchomalacia: focal, following tracheostomy or radiant therapy; or diffuse: idiopathic, polychondritis or Mounier-Kuhn syndrome
  • Tracheal or bronchial tumors: papillomatosis, amyloidosis
  • Post-inflammatory (Wegener’s disease)

Miscellaneous

  • Extrinsic compression due to aortic aneurysm
  • Tracheal distortion due to kyphoscoliosis
  • Tracheal obstruction by esophageal stent

Contraindications

  • There are no contraindications in the urgency
  • Affections of the larynx that prevent tracheal intubation with a rigid bronchoscope
  • Tracheostomy

Complications

  • Hemorrhage
  • Combustion
  • Perforation of the airway wall
  • Incrustation of secretions
  • Migration of the prosthesis
  • Colonization of the Stent

Method and Material

Out of the 100 patients treated, 40 had obstruction of the airway of benign etiology and 60 had neoplastic disease or its consequences.

The tracheobronchial recanalization treatment required the use of 86 silicone prostheses, to ensure ventilation.

Results

The recovery of lumen in the airway in all of them was achieved in cases with benign stenosis. One patient died at 6 weeks due to staphylococcal pneumonia.

Of the 60 patients with neoplastic disease, 55 (92%) recovered ventilation of the compromised area, with symptomatic improvement and followed the evolution of their underlying pathology. In the remaining 5 (8%), the unclogging was not possible because infiltrating endoluminal and intramural lesions were found. Intense bleeding was a complication that forced the interruption of the procedure in one case.

Conclusions

The recovery of airway clearance produces immediate relief for the patient with benign stenosis. In cases with neoplastic disease that have been excluded from open surgical resection, endoscopic recanalization offers them the possibility of a better survival and removes the immediate complications.

100 patients with tracheal or bronchial obstruction of benign or malignant nature were treated with radiofrequency electrocautery and / or mechanical dilatation with implant of 86 silicone prostheses, recovering the functionality of the airway in 95%.

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