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Makoto Takahama



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    P1.05 - Interventional Diagnostics/Pulmonology (Not CME Accredited Session) (ID 937)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.05-10 - Usefulness of Respiratory Dilatation Balloon in Tracheobronchial Stenosis Requiring Silicone Y-Stent Treatment (ID 12685)

      16:45 - 18:00  |  Author(s): Makoto Takahama

      • Abstract
      • Slides

      Background

      The Dumon silicone Y-stent (Novatech SA, La Ciotat, France) is useful for releasing tracheobronchial stenosis but requires sufficient predilation because of the weak expansion force of silicone Y-stents. We have performed mechanical expansion (debulking or coreout) by rigid bronchoscopy, microwave coagulation, and balloon expansion (Fogarty catheter). In recent years, however, we have used a respiratory dilatation balloon (CRE Pulmonary Balloon Dilator; Boston Scientific, Marlborough, MA). We investigated the feasibility, efficacy, and safety of stenting using a silicone Y-stent or additional self-expanding metallic stent (SEMS), focusing especially on the usefulness of a pulmonary balloon dilator, in patients with malignant tracheobronchial stenosis.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From May 2012 to November 2017, 75 patients (54 male, 21 female; mean age, 64 years; range, 30–91 years) who underwent Dumon silicone Y-stent placement for malignant tracheobronchial stenosis in our department were retrospectively examined. Forty-six patients had lung cancer, 20 had esophageal cancer, 5 had tracheal carcinoma, and 4 had other carcinomas. All procedures were performed in the operating room under general anesthesia, and the stents were implanted via rigid bronchoscopy. The patients were divided into three groups according to the method of predilatation before stenting: no use of balloon expansion (Group N, n=36), use of a Fogarty catheter (Group F, n=22), and use of a respiratory dilatation balloon (Group B, n=17).

      4c3880bb027f159e801041b1021e88e8 Result

      Stents were implanted and symptoms were resolved in all patients. No operative death occurred. The types of indwelling stents were only a Y-stent in 46 patients and a Y-stent with additional SEMS in 29. Although the mean number of additional SEMS was significantly higher in Group B (0.7 stents/patient) than in Groups N and F (0.3 stents/patient, respectively), there was no difference in the median (range) operation time among Groups N, F, and B: 55 (32–115), 59 (29–110), and 49 (17–102) minutes, respectively. In the 46 patients who underwent placement of only a Y-stent without a SEMS, the operation time was significantly shorter in Group B [n=6, 39 (17–64) minutes] than in Groups N [n=25, 53 (32–115) minutes] and F [n=15, 59 (29–106) minutes] (p=0.028). There were no differences in the amount of bleeding, postoperative performance status, or hospitalization days.

      8eea62084ca7e541d918e823422bd82e Conclusion

      A respiratory dilatation balloon is useful for predilatation in patients with tracheobronchial stenosis requiring a silicone Y-stent. Such balloons also contribute to a shorter operation time and more efficient procedure for severe stenosis requiring additional stenting.

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