Preliminary Experience with Bronchotherapeutic Procedures in Central Airway Obstruction

Background: Central airway obstruction is still challenging to physicians. We herein reporton our experiences with bronchotherapeutic procedures over a recent 8-month period.Methods: From January 2002 to August 2002, 21 patients received 26 procedures (4core outs, 6 dilations, 13 stent placements, 2 biopsies, and 1 foreign bodyremoval). All patients were treated with or assisted using a rigid bronchoscopetechnique, except in 1 case in which a fiber bronchoscope was used.The etiologies included 4 cases of lung cancer, 3 cases of malignancy-relatedtracheoesophageal fistula, 6 cases of airway intubation, 2 cases of laryngotrachealtuberculosis, 1 case of post-anastomotic stenosis, 1 case of laryngotrachealtrauma, 1 case of subglottic web, 1 case of foreign body, and 2 cases ofunknown origin.Results: Seventeen patients receiving bronchotherapeutic procedures benefited fromthe procedures, with 2 complications occurring in our series. One patientwho was 87 years old with esophageal cancer and tracheoesophageal fistuladied 5 days after the operation. Stent-related complications occurred in 2patients (1 collapse by compression and 1 mucous obstruction). No airwaylaceration occurred while performing the procedure. Two instances of intraoperativebleeding were encountered, which were successfully controlled bycompression of the lesion using the side of the rigid bronchoscope.Conclusions: In malignant airway obstructions, we resected the endobronchial tumor withthe tip of the rigid bronchoscope. Stents were reserved for patients withresidual obstruction or severe extrinsic compression. In benign airwayobstructions, dilation with a rigid bronchoscope was routinely used. Siliconstents were preferred for managing benign airway obstruction.