Preliminary experience with bronchotherapeutic procedures in central airway obstruction

Background: Central airway obstruction is still challenging to physicians. We herein report on our experiences with bronchotherapeutic procedures over a recent 8-month period. Methods: From January 2002 to August 2002, 21 patients received 26 procedures (4 core outs, 6 dilations, 13 stent placements, 2 biopsies, and 1 foreign body removal). All patients were treated with or assisted using a rigid bronchoscope technique, except in 1 case in which a fiber bronchoscope was used. The etiologies included 4 cases of lung cancer, 3 cases of malignancy-related tracheoesophageal fistula, 6 cases of airway intubation, 2 cases of laryngotracheal tuberculosis, 1 case of post-anastomotic stenosis, 1 case of laryngotracheal trauma, 1 case of subglottic web, 1 case of foreign body, and 2 cases of unknown origin. Results: Seventeen patients receiving bronchotherapeutic procedures benefited from the procedures, with 2 complications occurring in our series. One patient who was 87 years old with esophageal cancer and tracheoesophageal fistula died 5 days after the operation. Stent-related complications occurred in 2 patients (1 collapse by compression and 1 mucous obstruction). No airway laceration occurred while performing the procedure. Two instances of intraoperative bleeding were encountered, which were successfully controlled by compression of the lesion using the side of the rigid bronchoscope. Conclusions: In malignant airway obstructions, we resected the endobronchial tumor with the tip of the rigid bronchoscope. Stents were reserved for patients with residual obstruction or severe extrinsic compression. In benign airway obstructions, dilation with a rigid bronchoscope was routinely used. Silicon stents were preferred for managing benign airway obstruction.