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Ann Thorac Surg 2005;80:2419
© 2005 The Society of Thoracic Surgeons

Correspondence

Self-Expandable Metal Stents for Endobronchial Pathology

C.S. Pramesh, MS, FRCS, Rajesh C. Mistry, MS

Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012 India

(Email: cspramesh{at}vsnl.net).

To the Editor:

We read with interest Madden and colleagues' [1] article on the use of self-expandable metallic stents (SEMS) to manage endobronchial pathology. More than one third of the patients in their series have had SEMS placed for benign pathology. We strongly feel that SEMS have to be used very sparingly, if at all, in benign pathologies as they usually cause more harm than good. Grillo [2] famously (though critically) opined that "...[this] problem arises from the uncritical employment of technology without understanding the pathology being treated." The ease of deploying expandable metal stents has unfortunately resulted in their overuse. The SEMS cause long-term airway inflammation and granulation, are difficult to reposition or remove, and have the potential for airway perforation with prolonged implantation [2–4]. These problems are inconsequential in patients with malignant tracheobronchial obstruction, in which the life expectancy is too short for these complications to occur. Even if the authors claim they have not had any major problems with SEMS in the 15 patients analyzed, this forms a very small subgroup among their experience and cannot be considered as strong evidence. For benign tracheobronchial pathology, surgical resection is the treatment of choice whenever possible, and silicone stents may at best be used to tide over an acute situation or in cases in which length precludes surgical repair. The use of SEMS in benign pathology is a dangerous trend that needs to be seriously discouraged.

We also wonder why rigid bronchoscopy was used to deploy SEMS. We have regularly used flexible bronchoscopy under topical anesthesia for this purpose (for malignant tracheobronchial obstruction) and have rarely encountered problems. When performed under direct bronchoscopic vision combined with fluoroscopic guidance, accurate placement is possible as are minor adjustments in stent position immediately after deployment.


   References
Top
 References
 

  1. Madden BP, Park JES, Sheth A. Medium-term follow-up after deployment of ultraflex expandable metal stents to manage endobronchial pathology Ann Thorac Surg 2004;78:1898-1902.[Abstract/Free Full Text]
  2. Grillo HC. Stents and sense Ann Thorac Surg 2000;70:1142.[Free Full Text]
  3. Wood DE, Liu YH, Vallieres E, Karmy-Jones R, Mulligan MS. Airway stenting for malignant and benign tracheobronchial stenosis Ann Thorac Surg 2003;76:167-174.[Abstract/Free Full Text]
  4. Rodriguez AN, Diaz-Jimenez JP, Edell ES. Silicone stents versus metal stents for management of benign tracheobronchial disease: Con: Metal stents J Bronchol 2000;7:184-187.

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Brendan Madden and Abhijat Sheth
Ann. Thorac. Surg. 2005 80: 2419-2420. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., December 1, 2005; 80(6): 2419 - 2420.
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