Flexible bronchoscopy: A safe method for metal stent implantation in bronchial disease

Background. Endoscopic bronchoplastic procedures, such as metal stent impla ntation, are for safety reasons and mainly performed using rigid bronchosco py. Major complications, such as bleeding and accidental airway occlusion, are thought to be better managed with the rigid device. An increasing numbe r of pneumologists, however, use the flexible fiberscope for endobronchial stenting. Methods. Sixty-five stent implantations were performed in 51 patients with flexible fiberoptic bronchoscopy. We implanted 27 Tantalum Strecker stents (Boston Scientific Co, Watertown, MA), 20 Nitinol Accuflex stents (Boston S cientific Co) and 18 Wallstents (Schneider, Zurich, Switzerland). Underlyin g conditions were malignant disease in 84% and benign bronchial collapse in 16%. Sites of implantation were the trachea (45%), the main bronchi (35%), and other locations (20%). In 47 cases the patients received intravenous s edation combined with high frequency jet ventilation, and in 18 cases the p atients were treated with topical anesthesia alone. Results. Mean examination time was 58.3 (standard deviation 29.1) minutes. Eighty percent of patients experienced immediate clinical improvement in re spiratory symptoms. Spirometric parameters (forced expiratory volume in one second, peak expiratory flow rate, forced vital capacity) increased. Compl ications included hypertension (17%), hypotension (12%), hypoxia (5%), bron chospasm (4%), initial displacement of the prosthesis (11%), and diameter m ismatch between stent and bronchus (5%). All complications were managed saf ely. Relevant bleeding or asphyxia during the procedure has not been observ ed. Late stent migration was observed in 12% of cases. There were 3 fatalit ies within 30 days of stent placement which, however, were not attributed t o the implantation technique. Conclusions. Flexible fiberoptic bronchoscopy is a safe and suitable method to perform endobronchial metal stent implantation. Complications were rare and not serious. Initial misplacement of the prosthesis occurred in some c ases and necessitated removal and replacement within the same procedure. (C ) 2000 by The Society of Thoracic Surgeons.