J Korean Med Sci.  2023 Oct;38(39):e308. 10.3346/jkms.2023.38.e308.

Clinical Factors for Successful Removal of Airway Silicone Stents in Patients With Post-Tuberculosis Tracheobronchial Stenosis

• Kim BG
• Jeong BH
• Kim H

• KMID: 2546926
• DOI: http://doi.org/10.3346/jkms.2023.38.e308

Abstract

Background
After relieving stenosis with an airway silicone stent in post-tuberculosis bronchial stenosis (PTTS), stent removal is attempted if it is determined that airway patency can be maintained even after stent removal. However, the factors affecting airway stent removal are not well known. We investigate the factors that enable the successful removal of airway silicone stents in patients with PTTS.
Methods
We retrospectively analyzed PTTS patients who underwent bronchoscopic intervention from January 2004 to December 2019. Successful stent removal is defined as airway patency maintained when the stent is removed, so that reinsertion of the stent is not required. A multivariate logistic regression analysis was used to identify independent factors associated with successful stent removal at the first attempt.
Results
Total 344 patients were analyzed. Patients were followed up for a median of 47.9 (26.9–85.2) months after airway stent insertion. Approximately 69% of PTTS patients finally maintained airway patency after the stent was removed. Factors related to successful stent removal at the first attempt were older age and male sex. Absence of parenchymal calcification, segmental consolidation & bronchiolitis, and no trachea involved lesion were relevant to the successful stent removal. Stent dwelling for 12–24 months was associated with successful stent removal compared to a duration of less than 12 months.
Conclusion
For patients whose airway patency is determined to be maintained even without a stent, it is necessary to attempt stent removal in consideration of factors related to successful stent removal.

Keyword

Post-Tuberculosis Tracheobronchial Stenosis; Bronchoscopic Intervention; Airway Silicone Stent

Figure

• 

  Fig. 1 Flowchart of the study population.PTTS = post-tuberculosis tracheobronchial stenosis.aOf the 458 patients, 319 patients had stents placed in the first procedure, and 62 patients did not have stents placed in the first procedure but needed stents in subsequent procedures. Of these 381 patients, 37 patients were excluded from insufficient follow-up period after stenting, resulting in 344 patients.

Reference

1. Albert RK, Petty TL. Endobronchial tuberculosis progressing to bronchial stenosis. Fiberoptic bronchoscopic manifestations. Chest. 1976; 70(4):537–539. PMID: 975957.

2. Chung HS, Lee JH. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest. 2000; 117(2):385–392. PMID: 10669679.

3. Kim YH, Kim HT, Lee KS, Uh ST, Cung YT, Park CS. Serial fiberoptic bronchoscopic observations of endobronchial tuberculosis before and early after antituberculosis chemotherapy. Chest. 1993; 103(3):673–677. PMID: 8449050.

4. Smith LS, Schillaci RF, Sarlin RF. Endobronchial tuberculosis. Serial fiberoptic bronchoscopy and natural history. Chest. 1987; 91(5):644–647. PMID: 3105965.

5. Hsu AAL, Eng P, Ong YY. Bronchoscopic Management of Severe Airway Stenosis Caused by Past Tuberculosis: A Multimodality Approach. J Bronchol. 1999; 6(3):159–165.

6. Watanabe Y, Murakami S, Oda M, Hayashi Y, Ohta Y, Shimizu J, et al. Treatment of bronchial stricture due to endobronchial tuberculosis. World J Surg. 1997; 21(5):480–487. PMID: 9204734.

7. Ryu YJ, Kim H, Yu CM, Choi JC, Kwon YS, Kwon OJ. Use of silicone stents for the management of post-tuberculosis tracheobronchial stenosis. Eur Respir J. 2006; 28(5):1029–1035. PMID: 16971412.

8. Verma A, Um SW, Koh WJ, Suh GY, Chung MP, Kwon OJ, et al. Long-term tolerance of airway silicone stent in patients with post-tuberculosis tracheobronchial stenosis. ASAIO J. 2012; 58(5):530–534. PMID: 22929895.

9. Zakaluzny SA, Lane JD, Mair EA. Complications of tracheobronchial airway stents. Otolaryngol Head Neck Surg. 2003; 128(4):478–488. PMID: 12707649.

10. Lim SY, Park HK, Jeon K, Um SW, Koh WJ, Suh GY, et al. Factors predicting outcome following airway stenting for post-tuberculosis tracheobronchial stenosis. Respirology. 2011; 16(6):959–964. PMID: 21605277.

11. Eom JS, Kim H, Park HY, Jeon K, Um SW, Koh WJ, et al. Timing of silicone stent removal in patients with post-tuberculosis bronchial stenosis. Ann Thorac Med. 2013; 8(4):218–223. PMID: 24250736.

12. Verma A, Park HY, Lim SY, Um SW, Koh WJ, Suh GY, et al. Posttuberculosis tracheobronchial stenosis: use of CT to optimize the time of silicone stent removal. Radiology. 2012; 263(2):562–568. PMID: 22371608.

13. Shin B, Chang B, Kim H, Jeong BH. Interventional bronchoscopy in malignant central airway obstruction by extra-pulmonary malignancy. BMC Pulm Med. 2018; 18(1):46. PMID: 29534706.

14. Jeong BH, Ng J, Jeong SH, Kim H. Clinical Outcomes of Complications Following Self-Expandable Metallic Stent Insertion for Benign Tracheobronchial Stenosis. Medicina (Kaunas). 2020; 56(8):367. PMID: 32708022.

15. Kim HJ, Koh WJ, Suh GY, Chung MP, Kim JG, Suh SW, et al. The usefulness and safety of natural stent in a canine model of tracheal stenosis. Tuberc Respir Dis. 2002; 53(4):431–438.

16. Ryu YJ, Kim H, Yu CM, Choi JC, Kwon YS, Kim J, et al. Comparison of natural and Dumon airway stents for the management of benign tracheobronchial stenoses. Respirology. 2006; 11(6):748–754. PMID: 17052303.

17. Tay CK, Jeong BH, Kim H. Angulated stents-a novel stent improvisation to manage difficult post-tuberculosis bronchial stenosis. ASAIO J. 2018; 64(4):565–569. PMID: 29045278.

18. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978; 49(4):239–243. PMID: 697077.

19. Myer CM 3rd, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994; 103(4 Pt 1):319–323. PMID: 8154776.

20. Karush JM, Seder CW, Raman A, Chmielewski GW, Liptay MJ, Warren WH, et al. Durability of silicone airway stents in the management of benign central airway obstruction. Lung. 2017; 195(5):601–606. PMID: 28623537.

21. Jung SS, Park HS, Kim JO, Kim SY. Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis. Respirology. 2015; 20(3):488–495. PMID: 25620110.

22. Kashyap S, Solanki A. Challenges in endobronchial tuberculosis: from diagnosis to management. Pulm Med. 2014; 2014:594806. PMID: 25197570.

23. Lee JH, Park SS, Lee DH, Shin DH, Yang SC, Yoo BM. Endobronchial tuberculosis. Clinical and bronchoscopic features in 121 cases. Chest. 1992; 102(4):990–994. PMID: 1395814.

24. Rikimaru T, Kinosita M, Yano H, Ichiki M, Watanabe H, Shiraisi T, et al. Diagnostic features and therapeutic outcome of erosive and ulcerous endobronchial tuberculosis. Int J Tuberc Lung Dis. 1998; 2(7):558–562. PMID: 9661822.

25. Lee JY, Yi CA, Kim TS, Kim H, Kim J, Han J, et al. CT scan features as predictors of patient outcome after bronchial intervention in endobronchial TB. Chest. 2010; 138(2):380–385. PMID: 20299630.

26. Devi HG. Complications of pulmonary tuberculosis. Updated 2014. Accessed February 1, 2023. https://www.researchgate.net/publication/332750336_Complications_of_Pulmonary_Tuberculosis .

27. Shin B, Kim K, Jeong BH, Eom JS, Song WJ, Kang HK, et al. Clinical significance of differentiating post-intubation and post-tracheostomy tracheal stenosis. Respirology. 2017; 22(3):513–520. PMID: 27766714.

28. Chen Z, Luo J, Xu L, Ma R, Zhang N, Cui P. A model of canine tracheal stenosis induced by radiofrequency cauterization. Int J Pediatr Otorhinolaryngol. 2012; 76(2):183–188. PMID: 22136742.

29. Lee SS, Shin JH, Woo CW, Hwang JC, Park CS, Kim HJ, et al. A new model of tracheal stenosis in dogs using combined bronchoscopic electrocautery and ethanol injection. J Vasc Interv Radiol. 2008; 19(5):764–769. PMID: 18440467.

30. Jeong BH, Lee SH, Kim HH, Yoon HI, Eom JS, Park YS, et al. Trends and an online survey on the use of rigid bronchoscopy in Korea. J Korean Med Sci. 2023; 38(3):e13. PMID: 36647216.