title: Novel use of a percutaneous endoscopic gastrostomy tube fastener for securing silicone tracheal stents in patients with benign proximal airway obstruction.
abstract: BACKGROUND
  Benign tracheal obstruction occurs for a variety of reasons. Bronchoscopic intervention includes silicone stent placement, which effectively maintains airway patency. Stent migration is a common complication, particularly when placed in the proximal trachea. We used a novel technique of securing tracheal stents with a percutaneous endoscopic gastrostomy tube fastener (PEG-TF) to prevent stent migration. The purpose of this study was to determine the feasibility of securing silicone stents in the proximal trachea with PEG-TF.
  
  
  METHODS
  Silicone stents were placed under general anesthesia by rigid bronchoscopy in 7 consecutive patients with inoperable benign proximal tracheal obstruction. PEG-TFs were placed under sterile conditions with direct bronchoscopic visualization. A needle was inserted through the anterior neck and silicone stent wall allowing stylet introduction of a T-fastener into the interior of the stent. The T-fastener was secured externally by a metal clamp and cotton pledget at the surface of the neck. Patients had routine outpatient follow-up and covered the external portion of the PEG-TF with a waterproof dressing when showering.
  
  
  RESULTS
  All 7 PEG-TFs were placed without complications. The PEG-TFs were left in for 1 to 25 weeks. Complications of the PEG-TF included localized cellulitis and suture breakage. No stent migration occurred while the fastener was in place. Two stents were removed within 2 weeks due to patient's difficulty tolerating the stent.
  
  
  CONCLUSIONS
  Securing silicone stents in the proximal trachea is feasible and may prevent stent migration, but further study and possible modification of the PEG-TF device are needed.
authors.affiliation: National Jewish Health, Denver, CO, USA.
authors.forename: Ali I
authors.initials: AI
authors.lastname: Musani
authors.forename: Kurt
authors.initials: K
authors.lastname: Jensen
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
authors.forename: Michael
authors.initials: M
authors.lastname: Weyant
authors.forename: Katherine
authors.initials: K
authors.lastname: Garces
authors.forename: David
authors.initials: D
authors.lastname: Hsia
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000601:surgery*; D020878:Device Removal; D005240:Feasibility Studies; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control; D005773:Gastroscopy / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012828:Silicones; D015607:Stents; D014135:Tracheal Stenosis / Q000601:surgery*
chemical_list: D012828:Silicones