Silicone Airway Stent for Treating Benign Tracheoesophageal Fistula

2005 ◽  
Vol 13 (2) ◽  
pp. 178-180 ◽  
Author(s):  
Yun-Hen Liu ◽  
Po-Jen Ko ◽  
Yi-Cheng Wu ◽  
Hui-Ping Liu ◽  
Ying-Huang Tsai
Keyword(s):  
Tracheoesophageal Fistula ◽  
Ventilatory Support ◽  
Airway Patency ◽  
Tracheal Stent ◽  
Airway Stent

We used a silicone tracheal stent successfully to seal a huge benign tracheoesophageal fistula and restore airway patency after treatment with double metallic stenting of the trachea and esophagus failed. The patient was weaned from the ventilator 16 days after the procedure and after 7 months of ventilatory support.

scholarly journals Tracheoesophageal fistula due to a displaced external tracheal stent repaired using a local flap composed of intercostal muscle and rib periosteum

2019 ◽  
Vol 42 ◽  
pp. 48-50
Author(s):  
Kiichiro Yaguchi ◽  
Masahiko Noguchi ◽  
Yoshichika Yasunaga ◽  
Yuki Hoshino ◽  
Shunsuke Yuzuriha
Keyword(s):  
Tracheoesophageal Fistula ◽  
Local Flap ◽  
Intercostal Muscle ◽  
Tracheal Stent

Fetoscopic balloon dilation and stent placement of congenital high airway obstruction syndrome leading to successful Caesarian delivery

2022 ◽  
Author(s):  
Alice King ◽  
Joshua R. Bedwell ◽  
Deepak K. Mehta ◽  
Gary E. Stapleton ◽  
Henri Justino ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Stent Placement ◽  
Maternal Morbidity ◽  
Tracheoesophageal Fistula ◽  
Balloon Dilation ◽  
Laryngeal Stenosis ◽  
Tracheal Stent ◽  
Neonatal Hypoxia ◽  
Exit Procedure

Introduction: Without fetal or perinatal intervention, congenital high airway obstruction syndrome (CHAOS) is a fatal anomaly. The ex utero intrapartum treatment (EXIT) procedure has been used to secure the fetal airway and minimize neonatal hypoxia, but is associated with increased maternal morbidity. Case Presentation: A 16-year-old woman (gravida 1, para 0) was referred to our hospital at 31 weeks gestation with fetal anomalies, including echogenic lungs, tracheobronchial dilation and flattened diaphragms. At 32 weeks, fetoscopic evaluation identified laryngeal stenosis, which was subsequently treated with balloon dilation and stent placement. The patient developed symptomatic and regular preterm contractions at post-operative day 7 with persistent sonographic signs of CHAOS, which prompted a repeat fetoscopy with confirmation of a patent fetal airway followed by Cesarean delivery under neuraxial anesthesia. Attempts to intubate through the tracheal stent were limited and resulted in removal of the stent. A neonatal airway was successfully established with rigid bronchoscopy. Direct laryngoscopy and bronchoscopy confirmed laryngeal stenosis with a small tracheoesophageal fistula immediately inferior to the laryngeal stenosis and significant tracheomalacia. A tracheostomy was then immediately performed for anticipated long term airway and pulmonary management. The procedures were well tolerated by both mom and baby. The baby demonstrated spontaneous healing of the tracheoesophageal fistula by day of life 7 with discharge home with ventilator support at three months of life. Conclusion: Use of repeated fetoscopy in order to relieve fetal upper airway obstruction offers the potential to minimize neonatal hypoxia, while concurrently decreasing maternal morbidity by avoiding an EXIT procedure. Use of the tracheal stent in CHAOS requires further investigation. The long-term reconstruction and respiratory support of children with CHAOS remain challenging

scholarly journals Rapid Progression of Tracheoesophageal Fistula Caused by Immunotherapy Administered after Tracheal Stent Placement

2019 ◽  
Vol 4 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Shinjiro Mizuguchi ◽  
Makoto Takahama ◽  
Ryu Nakajima ◽  
Hidetoshi Inoue ◽  
Ryuichi Ito ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Tracheoesophageal Fistula ◽  
Metastatic Lymph Node ◽  
Rapid Development ◽  
Advanced Lung Cancer ◽  
Rapid Progression ◽  
Tracheal Stent ◽  
Line Therapy

Development of a tracheoesophageal fistula (TEF) is a serious complication of treatment for esophageal or lung cancer, especially following radiation therapy. However, development of a TEF as a complication of chemotherapy or tracheal stenting after surgical debulking is quite uncommon. We herein report a rare case involving a patient with advanced adenocarcinoma invading the mediastinum who rapidly developed a TEF after placement of a tracheal stent and administration of nivolumab immunotherapy. A 55-year-old heavy ex-smoker was diagnosed with lung adenocarcinoma with mediastinal invasion. Nine months after first-line therapy (chemotherapy and radiation therapy), he underwent treatment with nivolumab (3 mg/kg) as fourth-line therapy. Two weeks after the first dose, he underwent mechanical debulking of the tumor with tracheal stenting because of the rapid development of paraesophageal lymph node swelling and severe tracheal stenosis. He received a second dose of nivolumab 2 weeks later; however, imaging studies 12 days after this second dose revealed a huge fistula between the upper trachea and esophagus through a metastatic lymph node. Neither an additional stent nor replacement of the stent was considered because of the fistula site expansion and suffocation risk. Despite further treatment, the patient died of his primary disease 2 months later. Our findings will be of great interest to the readers, especially those involved in the clinical treatment of patients with advanced lung cancer treated by immunotherapy. The knowledge of potentially devastating TEF formation in the presence of transmural tracheal metastasis/invasion will allow clinicians to provide the best possible care for their patients.

scholarly journals Multidisciplinary management of laryngeal pathology identified in patients with COVID-19 following trans-laryngeal intubation and tracheostomy

2021 ◽  
pp. 175114372110346
Author(s):  
Sarah Boggiano ◽  
Thomas Williams ◽  
Sonya E Gill ◽  
Peter DG Alexander ◽  
Sadie Khwaja ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Ventilatory Support ◽  
Tertiary Hospital ◽  
Oral Feeding ◽  
Multidisciplinary Management ◽  
Language Therapy ◽  
Silent Aspiration ◽  
Airway Patency ◽  
Laryngeal Pathology ◽  
Swallowing Problems

Background COVID-19 disease often requires invasive ventilatory support. Trans-laryngeal intubation of the trachea may cause laryngeal injury, possibly compounded by coronavirus infection. Fibreoptic Endoscopic Evaluation of Swallowing (FEES) provides anatomical and functional assessment of the larynx, guiding multidisciplinary management. Our aims were to observe the nature of laryngeal abnormalities in patients with COVID-19 following prolonged trans-laryngeal intubation and tracheostomy, and to describe their impact on functional laryngeal outcomes, such as tracheostomy weaning. Methods A retrospective observational cohort analysis was undertaken between March and December 2020, at a UK tertiary hospital. The Speech and Language Therapy team assessed patients recovering from COVID-19 with voice/swallowing problems identified following trans-laryngeal intubation or tracheostomy using FEES. Laryngeal pathology, treatments, and outcomes relating to tracheostomy and oral feeding were noted. Results Twenty-five FEES performed on 16 patients identified a median of 3 (IQR 2–4) laryngeal abnormalities, with 63% considered clinically significant. Most common pathologies were: oedema (n = 12, 75%); abnormal movement (n = 12, 75%); atypical lesions (n = 11, 69%); and erythema (n = 6, 38%). FEES influenced management: identifying silent aspiration (88% of patients who aspirated (n = 8)), airway patency issues impacting tracheostomy weaning (n = 8, 50%), targeted dysphagia therapy (n = 7, 44%); ENT referral (n = 6, 38%) and reflux management (n = 5, 31%). Conclusions FEES is beneficial in identifying occult pathologies and guiding management for laryngeal recovery. In our cohort, the incidence of laryngeal pathology was higher than a non-COVID-19 cohort with similar characteristics. We recommend multidisciplinary investigation and management of patients recovering from COVID-19 who required prolonged trans-laryngeal intubation and/or tracheostomy to optimise laryngeal recovery.

scholarly journals Double hitch stitch is a novel technique for fixation of tracheal stent in a case of tracheoesophageal fistula: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Sameer A. Arbat ◽  
Parimal S. Deshpande ◽  
Sweta R. Chourasia
Keyword(s):  
Tracheoesophageal Fistula ◽  
Subcutaneous Tissue ◽  
Stent Migration ◽  
Esophageal Stent ◽  
Metallic Stent ◽  
Carcinoma Of The Esophagus ◽  
Tracheal Stent ◽  
Expandable Metallic Stent ◽  
Life Threatening

Abstract Background Caudal tracheal stent migration can be potentially life threatening by causing distal luminal obstruction. We present a rare double hitch stitch procedure (for prevention of migration of tracheal stent), which is an external fixation technique in a case of tracheoesophageal fistula with tracheal and esophageal self-expandable metallic stent (SEMS). Case presentation A 50-year-old male patient who presented with cough and dyspnea was a known case of carcinoma of the esophagus with esophageal stent in situ. Computed tomography (CT) scan showed tracheoesophageal fistula with esophageal stent (esophageal SEMS) migrating into the trachea. Tracheal stenting was done with SEMS. Patient was followed up after 1 month with recurrent complaints of cough on deglutition. On follow-up bronchoscopy, migration of stent was observed. A rare procedure of double hitch stitch was performed with fixation of the tracheal stent (tracheal SEMS) using a percutaneous anchoring stitch, embedded in the subcutaneous tissue. Follow-up bronchoscopy after 1 month of the procedure showed no migration of stent. Conclusion For the treatment of large tracheoesophageal fistula, stenting of both the trachea and the esophagus along with the double hitch stitch proved to be lifesaving. Stent migration prevention using “double hitch-stitch” is simple, safe, and successful, without any complications.

scholarly journals Aortopexy for Tracheomalacia Via Partial Sternotomy

2021 ◽  
pp. 25-29
Author(s):  
Zafer Turkyilmaz ◽  
Ramazan Karabulut ◽  
Ebru Ergenekon ◽  
Gokcen Emmez ◽  
Berrin Isik ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Esophageal Atresia ◽  
Supine Position ◽  
Tracheoesophageal Fistula ◽  
Ventilatory Support ◽  
Structural Disorder ◽  
Flexible Bronchoscopy ◽  
Tracheal Lumen ◽  
Tracheal Cartilage ◽  
Partial Sternotomy

Tracheomalacia (TM) is a disease that causes the airway obstruction of the tracheal lumen as a result of the structural disorder of the tracheal cartilage. We present a 4-month-old patient who developed ventilator depended TM after repair of esophageal atresia with tracheoesophageal fistula. Aortopexy and intraoperative flexible bronchoscopy were first performed via partial sternotomy in Turkey for this patient.  He was weaned from ventilatory support and extubated at the first  and discharged at the 8th post-operative day. Partial sternotomy is performed in the supine position, thus  it allows for intraoperative flexible bronchoscopy permitting to check for the adequacy of the aortopexy.

scholarly journals OBSTRUCTIVE APNEAS IN A MOUSE MODEL OF CONGENITAL CENTRAL HYPOVENTILATION SYNDROME

2021 ◽  
Author(s):  
Amélia Madani ◽  
Gabriel Pitollat ◽  
Eléonore Sizun ◽  
Laura Cardoit ◽  
Maud Ringot ◽  
...  
Keyword(s):  
Ventilatory Support ◽  
Gene Mutations ◽  
Original System ◽  
Hypoglossal Nucleus ◽  
Congenital Central Hypoventilation Syndrome ◽  
Airway Patency ◽  
Obstructive Apnea ◽  
Central Hypoventilation ◽  
Underlying Mechanisms ◽  
Hypoventilation Syndrome

AbstractRationaleCongenital Central Hypoventilation Syndrome is characterized by life-threatening sleep hypoventilation, and is caused by PHOX2B gene mutations, most frequently the PHOX2B27Ala/+ mutation. Patients require lifelong ventilatory support. It is unclear whether obstructive apneas are part of the syndrome.ObjectivesTo determine whether Phox2b27Ala/+ mice, which presented main symptoms of Congenital Central Hypoventilation Syndrome and died within hours after birth, also presented obstructive apneas and investigate potential underlying mechanisms.MethodsApneas were classified as central, obstructive or mixed by using an original system combining pneumotachography and laser detection of abdominal movement immediately after birth. Some respiratory nuclei involved in airway patency were analyzed by immunohistochemistry and electrophysiology in brainstem-spinal cord preparation.Measurements and Main ResultsThe median (interquartile range) of obstructive apnea frequency was 2.3/min (1.5-3.3) in Phox2b27Ala/+ pups versus 0.6/min (0.4-1.0) in wildtypes (P < 0.0001). Obstructive apnea duration was 2.7s (2.3-3.9) in Phox2b27Ala/+ pups versus 1.7s (1.1- 1.9) in wildtypes (P < 0.0001). Central and mixed apneas presented similar, significant differences. In Phox2b27Ala/+ preparations, hypoglossal nucleus had fewer neurons (P < 0.05) and smaller size (P < 0.01), compared to wildtypes. Importantly, coordination of phrenic and hypoglossal activities was disrupted, as shown by the longer and variable delay of hypoglossal with respect to phrenic onset, compared to wildtypes (P < 0.001).ConclusionsThe Phox2b27Ala/+ mutation predisposed pups not only to hypoventilation and central apneas, but also obstructive and mixed apneas likely due to hypoglossal dysgenesis. These results call for attention toward obstructive events in infants with Congenital Central Hypoventilation Syndrome.Subject category15.1 Animal Models of Sleep Apnea

Utility of stent double palliation for esophageal cancer with airway involvement: the extremis of care

2019 ◽  
Vol 33 (5) ◽  
Author(s):  
J Roseira ◽  
S Mão de Ferro ◽  
J Moleiro ◽  
P Currais ◽  
J Lemos ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Body Mass ◽  
Locally Advanced ◽  
Esophageal Stent ◽  
Symptom Improvement ◽  
Airway Patency ◽  
Airway Stent ◽  
Major Complications ◽  
Double Stent ◽  
Airway Stents

SUMMARY Primary esophageal cancer (EC) frequently presents as a locally advanced disease with airway involvement. Placement of combined esophageal and airway stents has been reported in small series to be an effective palliation strategy. Our aims are to present the largest cohort of EC patients who underwent double stent palliation and to evaluate the safety and efficacy of this approach. Longitudinal cohort study of patients with primary EC undergoing two-stage esophageal and airway stent placement at an oncology referral institute (January 2000–January 2019). Assessments: baseline demographics and clinical variables; baseline and week 2 dysphagia, dyspnea and performance status (PS) scores; baseline and week 8 body mass index (BMI); overall survival. Statistics: paired t-test; Kaplan–Meier method. Seventy patients (89% men, mean age 60.20 ± 8.41) underwent double stenting. Esophageal stent was placed for esophageal stenosis and dysphagia (n = 41; placement of a second stent due to recurrence in nine cases) or esophagorespiratory fistulas (ERFs) (n = 29); airway stent was required for ERF sealing (n = 29 + 7 new ERFs after esophageal stent) and to ensure airway patency due to malignant stenosis (n = 29; placement of a second stent due to recurrence in 13 cases) or compression (n = 5). There were 13, endoscopically managed, major complications after esophageal stent [hemorrage (n = 1), migration (n = 5) and new fistulas (n = 7)]. As for airway stents, four major complications were recorded [hemorrage (n = 1) and three deaths due to respiratory infection and ultimately respiratory failure 3–7 days after the procedure]. Overall, patients showed significant improvement in dysphagia and dyspnea symptoms (3.21 vs. 1.31 e 15.56 vs. 10.87; P &lt; 0.001). There was a PS improvement for 89.2% (n = 58) of the patients. BMI at week 8 was comparable to baseline records. Mean survival was 137.83 ± 24.14 days (95% CI: 90.51–185.15). Survival was longer for better PS (PS1, 249.95 days; PS2, 83.74 days; PS3, 22.43 days; PS4, 30.00 days). This is the largest comprehensive assessment of double stent palliation in advanced incurable EC. For both esophageal or airway stenosis and fistula, placement of combined esophageal and airway stents was a feasible, effective, fast-acting and safe modality for symptom palliation and body mass maintenance. Patient autonomy followed symptom improvement. Since it is impossible to provide treatment for cure in most of these cases, this endoscopic strategy, performed in differentiated units with the required technical capacity, may guarantee treatment for the relief of palliative EC.

scholarly journals Using individualized three-dimensional printed airway models to guide airway stent implantation

2020 ◽  
Vol 31 (6) ◽  
pp. 900-903
Author(s):  
Jesse Xu ◽  
Cameron Sullivan ◽  
Hui Xin Ong ◽  
Jonathan P Williamson ◽  
Daniela Traini ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Airway Patency ◽  
Airway Stent ◽  
Computed Tomography Images ◽  
Airway Obstructions ◽  
3D Printed ◽  
Stent Optimization ◽  
Airway Stents ◽  
Airway Model

Abstract Airway stents are used to manage central airway obstructions by restoring airway patency. Current manufactured stents are limited in shape and size, which pose issues in stent fenestrations needed to be manually created to allow collateral ventilation to airway branches. The precise location to place these fenestrations can be difficult to predict based on 2-dimensional computed tomography images. Inspiratory computed tomography scans were obtained from 3 patients and analysed using 3D-Slicer™, Blender™ and AutoDesk® Meshmixer™ programmes to obtain working 3D-airway models, which were 3D printed. Stent customizations were made based on 3D-model dimensions, and fenestrations into the stent were cut. The modified stents were then inserted as per usual technique. Two patients reported improved airway performance; however, stents were later removed due to symptoms related to in-stent sputum retention. In a third patient, the stent was removed a few weeks later due to the persistence of fistula leakage. The use of a 3D-printed personalized airway model allowed for more precise stent customization, optimizing stent fit and allowing for cross-ventilation of branching airways. We determine that an airway model is a beneficial tool for stent optimization but does not prevent the development of some stent-related complications such as airway secretions.

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