title: Placement of self-expandable bifurcated metallic stents without use of fluoroscopic and guidewire guidance to palliate central airway lesions.
abstract: BACKGROUND
  Self-expandable metallic stents (SEMS) can be used to treat malignant obstructions and fistulas of the central airways. SEMS can be placed using different methods. Recently, a rigid bronchoscope has been used for stent placement without the need for fluoroscopy. We retrospectively evaluated patients for whom SEMS were placed using a rigid bronchoscope, without employing guidewires or fluoroscopy. We describe the intra- and post-procedural complications of the method.
  
  
  METHODS
  Data collected between January 2014 and July 2015 were retrospectively evaluated by reference to hospital records.
  
  
  RESULTS
  The mean patient age was 58.14 ± 8.48 years (44-72 years) and 13 out of the 14 patients were male. Twelve had lung cancer, one a thyroid papillary carcinoma with a bronchomediastinal fistula, and one an esophageal carcinoma with a tracheoesophageal fistula. Covered metallic Y-shaped stents were placed in all patients. Before placement, argon plasma coagulation was performed on two patients, diode laser treatment on four, and de-obstruction on nine. No procedure-related mortality was noted. Only two patients required follow-up in the intensive care unit; they were moved to a regular ward after two days. No patient required stent replacement or repositioning. The most common early complication was mucus plugs.
  
  
  CONCLUSIONS
  Endobronchial placement of covered self-expandable metallic stents was safe and readily performed in patients with airway obstructions. Neither fluoroscopic nor guidewire guidance was required. Neither patients nor staff were exposed to radiation, and costly guidewire guidance was not necessary. The procedure is cost-effective.
authors.affiliation: Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Özdemir
authors.affiliation: Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey.
authors.forename: Sinem Nedime
authors.initials: SN
authors.lastname: Sökücü
authors.affiliation: Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Karasulu
authors.affiliation: Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Zeytinburnu, Istanbul, 34760 Turkey.
authors.forename: Seda Tural
authors.initials: ST
authors.lastname: Önür
authors.affiliation: School of Medicine, Department of Pulmonary Medicine, Istanbul Bilim University, Istanbul, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Dalar
keywords: Bronchoscopy; Central airways; Metallic stents