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Published on: January 21, 2020
Management of tracheobronchial obstruction in infants using metallic stents: long-term outcome
Ling Leung1, Patrick Ho Yu Chung, Kenneth Kak Yuen Wong
1Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong.
Insights
Metallic stents provide a safe and effective long-term solution for infants with tracheobronchial obstruction. This endoscopic approach led to good outcomes and ventilator weaning in a small patient cohort.
Area of Science:
- Pediatric Surgery
- Interventional Pulmonology
- Biomaterials in Medicine
Background:
- Tracheobronchial obstruction presents unique challenges in pediatric patients.
- Endoscopic metallic stenting is an emerging treatment for complex airway issues in infants.
- Long-term outcomes of this intervention in young children require further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of endoscopic metallic stenting in infants with tracheobronchial obstruction.
- To assess the safety and efficacy of metallic stents in this pediatric population.
- To identify potential complications and success factors associated with the procedure.
Main Methods:
- Retrospective review of pediatric surgical patients who underwent tracheobronchial metallic stenting (1996-2014).
- Analysis of patient demographics, obstruction etiology, and associated anomalies.
- Evaluation of outcome measures including complications, maximal tracheal diameter, ventilator weaning, and growth.
Main Results:
- Twelve metallic stents were placed in 5 infants (median age 13 months) for congenital tracheal stenosis or lymphatic malformation.
- Seven complications occurred, including granulation tissue, re-stenosis, stent migration, and fracture.
- All patients survived with good condition after a median follow-up of 16 years; 3 patients weaned off ventilator support.
Conclusions:
- Endoscopic metallic stenting demonstrates satisfactory long-term outcomes for treating tracheobronchial obstruction in infants.
- The procedure is a viable option for managing complex pediatric airway stenosis.
- Careful monitoring for complications is essential for successful long-term management.
Introduction:
Tracheobronchial obstruction, although uncommon in the pediatric age group, remains a challenging problem. We review the long-term outcome of endoscopic metallic stenting in infants with tracheobronchial obstruction.
Materials And Methods:
Medical records of all pediatric surgical patients who underwent tracheobronchial metallic stenting in our center were reviewed retrospectively from 1996 to 2014. Patients' demographic data, including etiology, associated anomalies and nature of obstruction were reviewed. Outcome measures include complications such as re-stenosis, granulation tissue, stent migration, fractured stent, maximal tracheal diameter achieved, weaning of ventilator and growth at interval follow-up.
Results:
Twelve balloon-expandable metallic stents were placed in the trachea (n = 10) and/or bronchi (n = 2) of 5 patients with a median age of 13 months (range 5-30 months). Etiology of the airway obstruction included congenital tracheal stenosis (n = 4), giant cervical and superior mediastinal lymphatic malformation with tracheobronchomalacia (n = 1). Seven complications were reported (3 patients developed granulation tissue, 2 patients had re-stenosis, 1 stent migrated, 1 stent fractured). All patients survived and were in good condition with a median follow-up of 16 years (range 11-18 years). Three patients weaned off ventilator and oxygen.
Conclusions:
Endoscopic stenting with metallic stent has satisfactory long-term outcome in treating infants with tracheobronchial obstruction.
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