title: The insertion of self expanding metal stents with flexible bronchoscopy under sedation for malignant tracheobronchial stenosis: a single-center retrospective analysis.
abstract: OBJECTIVE
  To describe a 10-year experience of inserting Ultraflex™ self-expanding metal stents (SEMS) under sedation using flexible bronchoscopy for the treatment of malignant tracheobronchial stenosis in a tertiary referral centre.
  
  
  METHODS
  Medical notes were retrospectively reviewed for all patients who underwent SEMS insertion between 1999 and 2009.
  
  
  RESULTS
  A data analysis of 68 patients who had Ultraflex™ SEMS inserted under sedation was completed. Thirty three males and 35 females with a mean age of 67.9 years (range 35-94) presented with features including dyspnea/respiratory distress (39 patients), stridor (16 patients) and hemoptysis/dyspnea (13 patients). Etiology of stenosis included lung cancer (46 patients) esophageal cancer (14 patients) and other malignancies (8 patients). Mean dose of midazolam administered was 5mg (range 0-10mg). The trachea was the most common site of stent insertion followed by the right and left main bronchus, respectively. Adjuvant laser therapy was applied at some stage in 31% of all cases, and chemotherapy and/or radiotherapy was administered to at least 64% of patients with malignant disease. Hemoptysis and stent migration were the most frequent complications (5 and 4 patients, respectively). The mean survival time of stented non-small cell lung cancer (NSCLC) patients was 214 days (range 5-1233) and that of esophageal malignancy was 70 days (range 12-249). Mean pack-year history of individuals with lung cancer requiring stent insertion was 37 (range 2-100).
  
  
  CONCLUSIONS
  Ultraflex stents offer a safe and effective therapy for patients who are inoperable or unresectable that otherwise would have no alternative therapy. It has an immediate beneficial effect upon patients, not only through symptom relief but, in some, through prolongation of life. Survival data is no worse than other studies using different varieties of stents and insertion techniques indicating its longer-term efficacy. Moreover, this report highlights the feasibility of performing this procedure successfully in a respiratory unit, without the need for general anesthesia.
authors.affiliation: Department of Respiratory Medicine, Northern General Hospital, Sheffield, United Kingdom. e.mcgrath@sheffield.ac.uk
authors.forename: Emmet E
authors.initials: EE
authors.lastname: McGrath
authors.forename: David
authors.initials: D
authors.lastname: Warriner
authors.forename: Paul
authors.initials: P
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001982:Bronchial Diseases / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D002277:Carcinoma / Q000150:complications* / Q000401:mortality / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D016292:Procedural Sedation; D003251:Constriction, Pathologic; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D006993:Hypnotics and Sedatives; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D010166:Palliative Care; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D015607:Stents; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam