PURPOSE: Airway lumen and stenosis measurements have traditionally been accomplished through methods such as computed tomography (CT), fluoroscopy, and a physician’s estimate at endoscopy. In cases where size estimates are inaccurate, subsequent complication rates may increase, putting the patient at risk. In order to refine the lumen sizing process, a novel lumen sizing device for use under direct visualization has been introduced.
METHODS: The measuring device incorporates a coaxial sheath over a color coded wire that fits through the working channel of an endoscope. When the handle of the device is actuated, measuring arms expand in the airway lumen resulting in the display of a color indicator in a small window that correlates to a diameter value in millimeters (mm). The outer sheath is also marked in 5mm increments for measurement of length. Measurements were taken during endoscopy for a patient presenting with a tracheo-esophageal (TE) fistula and intrinsic stenosis of the trachea resulting from squamous cell cancer. The airway stenosis was dilated with a pulmonary balloon dilator and a stent was implanted.
RESULTS: The luminal measuring device was applied displaying measurements 18mm proximal to the lesion, 16 mm distal and 10mm at the stricture site and 60mm in length from proximal to distal. The stricture was ballooned to 15mm and measurements were taken again. Post dilation, the lumen measured 18mm proximal to the lesion, 15mm at the stricture and 16mm distal. A 16mm × 60 mm stent was selected and implanted.
CONCLUSION: The luminal measuring device was applied under direct visualization providing a real time measurement of the airway. This eliminated the under and overestimate errors associated with CT scanning. These direct measurements also assisted in selecting an appropriate pulmonary balloon dilator and implant.
CLINICAL IMPLICATIONS: The increased accuracy in the selection of properly sized equipment and implants could be beneficial in decreasing the complications commonly associated with stent sizing errors and the cost of repeated procedure.
DISCLOSURE: Gurpreet Sandhu, None.