Palliation of tracheobronchial malignant obstruction with metal stents in emergency conditions.
BACKGROUND
Endoluminal obstruction, caused by tracheobronchial malignancies, can require urgent treatment in case of severe respiratory distress. In emergencies, self-expanding metal stents can be endoscopically employed to solve acute symptoms.


METHODS
Between April 1992 and August 1996, 7 patients were treated by positioning of metal stents in emergency conditions and observed to verify the immediate efficacy of endoscopic therapy. Tracheal stenosis, stenosis of trachea and right main bronchus and obstruction of trachea and left main bronchus were present in 5, 1 and 1 patient, respectively. Metal stents for intravascular use (Wallstent, Schneider, Zurich, Switzerland) were positioned on a guide wire by fiber- or video-bronchoscope, after local anaesthesia, monitoring the arterial oxygen saturation of every patient.


RESULTS
In six patients breathlessness was resolved immediately. The last patient, suffering from severe mediastinal involvement, died from cardiac failure. No complication occurred. Mean survival was 40 days.


CONCLUSIONS
Self-expanding metal stent placement is an easy and safe method, does not require general anaesthesia, is less traumatic and well tolerated, is quick to be performed and then can be used in emergencies. Nevertheless, it is impossible to remove the stent in case of malpositioning. Although this group is small, endobronchial stenting using metallic prostheses permits immediate ventilation and palliation of large airway obstruction.
Department of Diagnostic and Surgical Endoscopy, Istituto Nazionale Tumori, Milano.
P
P
Spinelli
F G
FG
Cerrai
A
A
Spinelli
D000368:Aged; D000402:Airway Obstruction / Q000601:surgery; D001982:Bronchial Diseases / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015607:Stents; D014135:Tracheal Stenosis / Q000601:surgery*