Flexible bronchoscopic insertion of self-expanding metal stents in malignant tracheal lesions without fluoroscopic guidance

Background: Self-expanding metal stents (SEMS) are a well-accepted treatment modality for malignant tracheobronchial obstruction or malignant tracheoesophageal fistulae (TEFs). The traditional approach to SEMS insertion in central airway obstruction (CAO) has been rigid bronchoscopy performed under general anesthesia. Fluoroscopic guidance is sometimes utilized. Safe and accurate placement of tracheobronchial SEMS has also been described using flexible bronchoscopy. We herein describe our experience with tracheal SEMS insertion using flexible bronchoscopy without fluoroscopic guidance. Methods: A retrospective analysis of the bronchoscopy records was undertaken for the duration June 2012 to June 2014. Patients with malignant CAO or malignant TEF who underwent tracheal SEMS insertion using flexible bronchoscopy were included. Procedures were performed under mild sedation. Fluoroscopic guidance was not utilized. Results: Eleven patients were identified. The mean age was 60.9 (12.8) years. There were 6 males and 5 female patients. Most common indication for tracheal SEMS was CAO (9/11) followed by TEF (2/11). Stent deployment could be accomplished successfully and at the desired location in all the patients. All patients reported immediate symptomatic relief. Two patients experienced peri-procedural respiratory failure that recovered within 24 h. There was no procedure related mortality or other major complications. Conclusion: Insertion of tracheal SEMS in patients with malignant CAO/TEF using flexible bronchoscopy under minimal sedation is a safe and efficacious modality that can be performed without fluoroscopic guidance.