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Interactive Cardiovascular and Thoracic... Aug 2021Stent migration is a common complication of airway stent placement for upper tracheal stenosis and tracheoesophageal fistula. Although several researchers have reported...
OBJECTIVES
Stent migration is a common complication of airway stent placement for upper tracheal stenosis and tracheoesophageal fistula. Although several researchers have reported that external fixation is effective in preventing stent migration, the usefulness and safety of external fixation have not been proved because their cohorts were small. We therefore investigated the efficacy and safety of external fixation during upper tracheal stenting.
METHODS
Records of patients who underwent airway stent placement from May 2007 to August 2018 in a single centre were retrospectively reviewed. We included only patients whose stent had been placed in the upper trachea with external fixation to the tracheal wall. The primary endpoint of this study was the rate of stent migration.
RESULTS
Altogether, 51 procedures were performed in 45 patients (32 males, 13 females; median age 60 years, range 14-91 years). The median follow-up period was 9 months (range 0.3-90 months). Among the procedures, 15 were performed for benign disease and 36 for malignancy. Stents were composed of either silicone (n = 42) or metal (n = 9). Stent migration occurred in 3 (6%) patients. The stents with migration were all composed of silicone. Other sequelae were granulation tissue formation in 10 (20%) patients, sputum obstruction in 6 (12%), cellulitis in 3 (6%) and pneumonia in 1 (2%).
CONCLUSIONS
External fixation was an effective method for preventing migration of airway stents placed for upper tracheal stenosis and tracheoesophageal fistula. The complications were acceptable in terms of safety.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Airway Obstruction; External Fixators; Female; Fracture Fixation; Humans; Male; Middle Aged; Retrospective Studies; Stents; Tracheal Stenosis; Tracheoesophageal Fistula; Treatment Outcome; Young Adult
PubMed: 33880543
DOI: 10.1093/icvts/ivab098 -
Swiss Medical Weekly Dec 2020Tracheal or cricotracheal resection is the standard of care for definitive treatment of tracheal stenosis. However, the incidence is low, the management is complex, and...
BACKGROUND
Tracheal or cricotracheal resection is the standard of care for definitive treatment of tracheal stenosis. However, the incidence is low, the management is complex, and only a few centres have reported their experience. Therefore, more clinical reports on this topic are needed.
METHODS
We performed a retrospective analysis of all patients who underwent tracheal or cricotracheal resection for malignant or benign tracheal stenosis in our institution between 2001 and 2016. Fisher’s exact test was used for analysis of complications and recurrence. P-value <0.05 was considered statistically significant.
RESULTS
37 patients, aged 19–74, underwent tracheal (n = 21, 56.8%) or cricotracheal (n = 16, 43.2%) resection for idiopathic (n = 15, 40.5%), neoplasm-related (n = 11, 29.7%), postintubation/-tracheotomy (n = 10, 27%), and congenital (n = 1, 2.7%) stenosis. Cervical incision was applied in 28 patients (75.7%), and an extended access (5 thoracotomy, 3 hemiclamshell, 1 partial-sternotomy) was required in 9 patients (24.3%). Mediastinal lymphadenectomy was done in 7 patients (18.9%), all with neoplasm-related stenosis. Median resection length was 2.8 cm (range 1.0–6.0), and longer than 4.0 cm in 6 cases (16.2%). Release manoeuvre was performed in 7 patients (18.9%). All patients were extubated immediately after surgery and median hospital stay was 5 days (range 3–15). Median follow-up was 6 months (range, 1-93). There was no 30-day mortality, and no dehiscence or fistula occurred at the suture line. Complications were seen in 11 patients (29.7%), significantly correlating to malignant stenosis (p = 0.011) and surgical procedure, meaning extended access (p = 0.011), mediastinal lymphadenectomy (p = 0.016), and release manoeuvres (p = 0.016). Temporary hoarseness was the most common complication (n = 5, 13.5%), but remained persistent in only one patient (n = 1, 2.7%). Recurrence was seen only in patients with idiopathic stenosis (n = 5, 13.5%).
CONCLUSIONS
Our results confirm good efficacy for surgical resection of tracheal stenosis. The complication rate is relatively low in comparison to the literature, suggesting the importance of managing tracheal stenosis in a tertiary referral centre.
Topics: Anastomosis, Surgical; Humans; Postoperative Complications; Retrospective Studies; Trachea; Tracheal Stenosis; Treatment Outcome
PubMed: 33378546
DOI: 10.4414/smw.2020.20383 -
Multimedia Manual of Cardiothoracic... 2016Acquired non-malignant tracheo-oesophageal fistula (TOF) most commonly develops after prolonged intubation or tracheostomy. It may also develop after trauma,...
Acquired non-malignant tracheo-oesophageal fistula (TOF) most commonly develops after prolonged intubation or tracheostomy. It may also develop after trauma, oesophagectomy, laryngectomy and other disparate conditions. TOF leads to respiratory compromise secondary to chronic aspiration and pulmonary sepsis. Difficulty with oral intake usually leads to nutritional compromise. After diagnosis, the goals are to eliminate or reduce ongoing pulmonary contamination and to restore proper nutrition. Operative repair of benign TOF is generally performed through a cervical approach. The majority of patients require tracheal resection and reconstruction to address concomitant tracheal or laryngotracheal stenosis. Muscle flap interposition between tracheal and oesophageal repairs reduces the risk of fistula recurrence. Operative repair of the fistula is associated with generally good outcomes with a minimal risk of mortality.
Topics: Humans; Intubation, Intratracheal; Suture Techniques; Tracheal Stenosis; Tracheoesophageal Fistula; Tracheostomy
PubMed: 26933202
DOI: 10.1093/mmcts/mmw002 -
Development (Cambridge, England) Jul 2021The trachea delivers inhaled air into the lungs for gas exchange. Anomalies in tracheal development can result in life-threatening malformations, such as...
The trachea delivers inhaled air into the lungs for gas exchange. Anomalies in tracheal development can result in life-threatening malformations, such as tracheoesophageal fistula and tracheomalacia. Given the limitations of current therapeutic approaches, development of technologies for the reconstitution of a three-dimensional trachea from stem cells is urgently required. Recently, single-cell sequencing technologies and quantitative analyses from cell to tissue scale have been employed to decipher the cellular basis of tracheal morphogenesis. In this Review, recent advances in mammalian tracheal development and the generation of tracheal tissues from pluripotent stem cells are summarized.
Topics: Animals; Cartilage; Cell Differentiation; Epithelium; Humans; Lung; Mesoderm; Mice; Morphogenesis; Respiratory System; Trachea; Tracheoesophageal Fistula; Tracheomalacia; Transcriptome
PubMed: 34228796
DOI: 10.1242/dev.198192 -
The Journal of Thoracic and... May 2021
Topics: Bronchi; Fistula; Humans; Printing, Three-Dimensional; Stents; Trachea
PubMed: 32334885
DOI: 10.1016/j.jtcvs.2020.03.064 -
Annals of Gastroenterology 2019Tracheoesophageal fistulas (TEF) are pathologic communications between the trachea and esophagus. TEF can lead to significant respiratory distress that may result in... (Review)
Review
Tracheoesophageal fistulas (TEF) are pathologic communications between the trachea and esophagus. TEF can lead to significant respiratory distress that may result in lethal respiratory compromise, often due to recurrent and intractable infections. Through the use of endoscopy, some TEF can be successfully repaired using different approaches depending on the size, location, availability, and experience of the treating endoscopist. The aim of this manuscript is to provide an up-to-date review of the endoscopic management of TEF for gastroenterologists.
PubMed: 30598588
DOI: 10.20524/aog.2018.0321 -
Revista de Gastroenterologia de Mexico 2014
Topics: Anal Canal; Child; Esophageal Fistula; Esophagus; Heart Defects, Congenital; Humans; Kidney; Limb Deformities, Congenital; Male; Radiography; Spine; Trachea
PubMed: 24875595
DOI: 10.1016/j.rgmx.2013.07.009 -
Indian Journal of Thoracic and... Mar 2021Congenital broncho-oesophageal fistulae (CBEF) are foregut developmental anomalies. They are formed due to the persistent attachment between the developing tracheal bud...
Congenital broncho-oesophageal fistulae (CBEF) are foregut developmental anomalies. They are formed due to the persistent attachment between the developing tracheal bud and the foregut in the embryo. They commonly present in young age and patients present with symptoms of recurrent respiratory tract infections and low body weight. Only one case of a double CBEF has been reported in literature so far. Here we present a congenital double barrel broncho-oesophageal fistula in a middle aged lady, which is a rare presentation. Definitive treatment involves division and repair of the fistula along with resection of the damaged portion of lung in select cases. We publish these images due to the rarity of a double fistula.
PubMed: 33642718
DOI: 10.1007/s12055-020-01047-3 -
BMC Pulmonary Medicine Jan 2021Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal... (Comparative Study)
Comparative Study
BACKGROUND
Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.
METHODS
We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.
RESULTS
The technical success rate of stent removal was 98.9 and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1 ± 25.9 days in the TF group, and at 89.9 ± 15.0 day in the TS group. The total incidence of complications was 21.1 and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3, 59.6, and 36.1% for TF group, and 80.4, 75.7, 75.7% for TS group.
CONCLUSIONS
Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Clinicians should pay attention to the risk of hemoptysis for patients with malignant tumors and a combination with endoscopic hemostasis may help improve its safety.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Device Removal; Duration of Therapy; Female; Fluoroscopy; Humans; Male; Middle Aged; Postoperative Complications; Recurrence; Respiratory Tract Fistula; Retrospective Studies; Stents; Tracheal Diseases; Tracheal Stenosis; Young Adult
PubMed: 33413278
DOI: 10.1186/s12890-020-01349-7 -
Endoscopic interventional therapies for tracheoesophageal fistulas in children: A systematic review.Frontiers in Pediatrics 2023An electronic literature search was performed using the keywords "tracheoesophageal fistula," "endoscopic," and "children" in the four major medical databases (Ovid,... (Review)
Review
METHODS
An electronic literature search was performed using the keywords "tracheoesophageal fistula," "endoscopic," and "children" in the four major medical databases (Ovid, Embase, PubMed, and Web of Science) right from inception to September 2022. All English language articles describing the endoscopic interventional therapies of TEF in children were reviewed. Two independent researchers screened eligible articles at the title and abstract level. Full texts of potentially relevant articles were then screened again, and reference lists were screened manually to identify additional studies. Relevant data were extracted and analyzed. A synthesis of the relevant data was presented in descriptive form because of the heterogeneity of the included articles. The Chi-Squared test was used with a significance level of 5% (< 0.05).
RESULTS
Among the 1,167 retrieved papers, a total of 46 studies describing 170 TEF patients with an age range of 0.3-175 months were included, including 11 cases of acquired tracheoesophageal fistula, 144 cases of recurrent tracheoesophageal fistula, and 15 cases of congenital tracheoesophageal fistula (H-type TEF). A total of 119 out of 170 fistulas were successfully blocked endoscopic techniques with an overall success rate of 70.0%, while 48 fistulas failed to close by endoscopic interventions, following which the procedure was converted to open surgery. No obviously severe intraoperative/postoperative complications occurred during the follow-up period, but only a mild esophageal stricture was noticed in six patients and grade II tracheal stenosis in one patient. Two patients died from causes unrelated to endoscopic procedures, with a mortality rate of approximately 1.2%. A comparative assessment of different endoscopic interventional techniques for TEF that detected endotracheal stenting was performed in six patients and one fistula was successfully blocked (16.7%). De-epithelialization alone was performed in 65 patients and the fistula healed in 47 of them (72.3%), with the mean number of successful treatments required being 2.3 times. Chemical sealant injection was administered in 33 patients and success was achieved in 21 (63.6%). The average requirement for endoscopic procedures was 1.5 times. De-epithelialization, in combination with chemical sealant injection, was performed in 62 patients, achieving the highest success rate of 77.4% (48 patients). Other treatment methods were performed in four patients and successfully treatment outcomes were reported in two of them (50.0%). The mean number of successful treatments required was four times, and a treatment was converted to surgery in one patient (25.0%). An assessment of different TEF types showed that 9 out of 15 congenital TEFs, 7 out of 11 acquired TEFs, and 103 out of 144 recurrent TEFs were successfully occluded. A comparison of the success rate across multiple groups showed a significant difference with a score of < 0.05, while there was no significant difference in the success rate of different TEF-type groups (> 0.05).
CONCLUSION
Endoscopic intervention is currently a preferred treatment modality for children with TEF because of its less-invasive nature, less complications, and high success rate. Among all interventional techniques, de-epithelialization, in combination with chemical sealant, has a higher success rate than other techniques. However, due to the limited number of cases reported for implementing many kinds of techniques, an ideal endoscopic interventional technique has yet to be devised, often necessitating more treatment applications and close follow-up.
PubMed: 36911034
DOI: 10.3389/fped.2023.1121803