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Ann Thorac Surg 1997;63:1512-1513
© 1997 The Society of Thoracic Surgeons

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Correspondence

Which Stent to Use for Tracheobronchial Stenoses: Metallic or Silicone?

Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Nt, Hong Kong, e-mail:yimap{at}cuhk.edu.hk

To the Editor:

We read with interest the reported experience by Takamori and associates [1] on the use of a Gianturco stent for tracheobronchial stenoses secondary to esophageal carcinoma. Takamori and associates advocated the metallic stent because it could be inserted under local anesthesia and symptomatic relief was achieved in 8 of 12 patients (67%).

Esophageal carcinoma is one of the most common cancers in Hong Kong, and over the last 3 years, we have inserted 17 silicone stents (Dumon Stent; Cometh, Marseille, France) in 15 patients with tracheobronchial stenoses resulting from esophageal carcinoma [2]. This was performed using total intravenous anesthesia (2,6-disopropylphenol or propofol; Zeneca, Macclesfield, Cheshire, UK) and assisted spontaneous ventilation. The stenoses were successfully dilated using the ventilating rigid bronchoscope (Efer-Dumon Bronchoscope; Efer, La Ciotat, France) in all cases. Tumor infiltration of the membranous trachea was observed in the majority of cases. One or two studded silicone stents (Dumon) were inserted using a dedicated introducer through the bronchoscope in each case.

We saw no intraoperative complication or procedure-related mortality. All the patients had symptomatic relief (mean dyspnea relief by visual analogue scale, 7.8 on a scale of 1 to 10 with 10 being complete relief). All patients tolerated the procedure well.

In the absence of a prospective, randomized study, it would be difficult to conclude which stent, metallic or silicone, is better. However, we are impressed with our described technique (using total intravenous anesthesia and ventilating rigid bronchoscopy), which allows safe control of the airway and permits further intervention if need be. The studded silicone stent is easy to insert and remove and does not lead to the dreaded complication of trachea erosion or tumor/granulation growth between the wires, which is intrinsically associated with the Gianturco stent [3].

References

1. Takamori S, Fujita H, Hayashi, A, et al. Expandable metallic stents for tracheobronchial stenoses in esophageal cancer. Ann Thorac Surg 1996;62:844–7.[Abstract/Free Full Text]
2. Yim APC, Abdullah V, Ho JKS, van Hasselt CA. Video assisted interventional bronchoscopy-the Hong Kong experience. Surg Endosc (in press).
3. Nomori H, Kobayashi R, Kodera K, Morinaga S, Ogawa K. Indications for an expandable metallic stent for tracheobronchial stenosis. Ann Thorac Surg 1993;56:1324–8.[Abstract]

Reply

First Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830, Japan

To the Editor:

I thank Dr Yim and associates for their comments on our report of metallic stents for tracheobronchial stenoses in esophageal cancer [1].

My colleagues and I agree with their concern about the controversy of which stent, metallic or silicone, is better. Their technique of silicone stent insertion for tracheobronchial stenoses resulting from esophageal carcinoma is excellent. Although we have little experience in the use of the silicone stent, the technique using a rigid bronchoscope remains invasive and the procedure requires an experienced endoscopist and a skilled anesthesiologist. A Gianturco stent is easy to insert by using a flexible fiberscope under local anesthesia, which is favorable when the patient is severely compromised. On the point of comparative cost, the metallic stent is inexpensive because the stent is made by ourselves, whereas the silicone stent is quite expensive.

Tracheobronchial erosion or tumor/granulation growth between the wires, which is intrinsically associated with the Gianturco stent, is a disadvantage in permanent stent application. A silicone stent may be indicated for such a condition. We consider stenting to be palliative only and a local therapy for tracheobronchial stenoses; additional modalities such as irradiation, chemotherapy, and especially laser treatment are recommended [2].

References

1. Takamori S, Fujita H, Hayashi A, et al. Expandable metallic stents for tracheobronchial stenoses in esophageal cancer. Ann Thorac Surg 1996;62:844–7.
2. McElvein RB. Treatment of malignant tracheobronchial obstruction. Ann Thorac Surg 1989;48:463–4.[Medline]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anthony P. C. Yim Mohammad Bashar Izzat Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yim, A. P. C. Articles by Takamori, S. Search for Related Content PubMed PubMed Citation Articles by Yim, A. P. C. Articles by Takamori, S.