Use of a modified endotracheal tube for self-expandable metallic Y-shaped airway stent deployment without rigid bronchoscope or fluoroscopic guidance

摘要

Background: Self-expandable metallic Y-shaped airway stents (SEMYS) are commonly used in the management of airway stenosis and fistulae caused by thoracic neoplasms. Methods: A new technique using a slightly modified regular endotracheal tube has been developed for the deployment of SEMYS with flexible bronchoscopy alone. The technique and devices are described. Results: To date, successful deployment of SEMYS with this method has been carried out successfully in 17 out of 20 patients without major complications while the other 3 required conversion to rigid bronchoscopy because of limited pharyngeal cavity space, massive hemorrhage and severe cicatrization of the airway, respectively. Conclusions: This simplified deployment technique with the modified endotracheal tube enables safe, simple and fast insertion of SEMYS in a regular bronchoscopy suite, which may benefit the vast less privileged institutions where SEMYS are necessary but rigid bronchoscopy and fluoroscopy are not available. The skill of the bronchoscopist, cautious selection of patients and effective coordination of the operating team are crucial for the procedure.