SESSION TITLE: EBUS and Advanced Bronchoscopy Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Airway obstruction secondary to external compression is a frequent indication for stent placement. The location where the tumor exerts the highest pressure is known as the “choke point”. A possible complication of stent placement is the shift of the “choke-point” proximal or distal to the end of the stent. This complication renders the stent useless as it no longer maintains the patency of the airway. We describe a technique to prevent “choke-point” migration by estimating the length of endoscopically normal airway extrinsically involved by the tumor and consider choke point shifting when choosing the desired length of the airway stent.
METHODS: Retrospective study of seven consecutive cases with critical central airway obstruction secondary to external compression where the CP-EBUS was used to determine the length of the tumor and estimate potential “choke point” shifts to guide stent placement. Technique Description: Airway CT with 3-D reconstructions identify the location, extension and choke-point prior to bronchoscopy. Rigid bronchoscopy (RB) is done under general anesthesia with careful positioning in the proximal trachea. The flexible bronchoscope (FB) is advanced and distal airways are evaluated for endobronchial disease. The FB is exchanged for the dedicated CP-EBUS bronchoscope and diagnostic tissue is obtained in the distal, middle and proximal ends of the tumor. Using a 21g EBUS/TBNA needle, markings are left in the mucosa to help measure the length of the stent to be placed. A minimum of 5 mm of excess length proximally and distally are suggested to minimize the risk of inaccurate calibration.
RESULTS: Eleven stents were placed in seven patients with critical airway obstruction secondary to external compression with CP- EBUS guidance and RB. All patients had large tumors involving the trachea and main stem bronchi. There were no cases of “choke-point” migration distal or proximal to the stent, on post-procedure bronchoscopy and airway CT. Four patients required more than one stent to cover the length of the tumor, while two required a Y silicone stent. There were no periprocedural complications.
CONCLUSIONS: The use of CP-EBUS to guide the placement of airway stents in patients with critical central airway obstruction secondary to external compression is safe and effective. In the presence of large tumors more than one stent may be necessary.
CLINICAL IMPLICATIONS: This novel technique is safe and effective in preventing "choke-point" migration from external compression by large tumors.
DISCLOSURE: Erik Folch: Consultant fee, speaker bureau, advisory committee, etc.: Scientific advisor for Boston Scientific, Consultant fee, speaker bureau, advisory committee, etc.: Education advisor for Olympus The following authors have nothing to disclose: Matthew Kinsey, Omar Ibrahim, Amit Mahajan, Eugene Shostak, Adnan Majid
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