silicon and Bronchial-Fistula

Bronchobiliary fistulas (BBFs), defined as abnormal connections between a bronchus and the bile duct, are rare. Bronchial occlusion with silicon spigots under radiographic guidance is a good alternative means of treating a BBF when surgical intervention is considered too risky. A 60-year-old man had a diagnosis of intrahepatic cholangiocarcinoma and underwent chemotherapy. Obstructive jaundice developed and was treated with percutaneous transhepatic cholangiography drainage (PTCD). Subsequent bronchoscopy with contrast medium through the PTCD tube enabled identification of a BBF and the responsible bronchus, which was occluded with silicon spigots. There were no complications after this procedure.

Topics: Biliary Fistula; Bronchial Fistula; Cholangiography; Drainage; Humans; Male; Middle Aged; Silicon

Esophagobronchial fistula (EBF) formation is a severe complication of advanced thoracic malignancies, that affects the prognosis and quality of life of patients. This study reports the case of an 80-year-old man with advanced esophageal cancer, complicated by EBF formation in the left main bronchus proximal to the carina following chemoradiation therapy. A fully covered stent was placed in the left main bronchus but was dislocated on the oral side. The attempt to place a partially covered self-expandable metallic stent (SEMS) also failed due to stent dislocation on the oral side. To avoid stent dislocation, a partially covered SEMS with a length of 40 mm and a diameter of 16 mm was placed to cover the EBF in the left main bronchus. Then, a silicone Y stent (16 × 13 × 13 mm in outer diameter) was inserted to support the SEMS from the inside. After placing the SEMS and Y stent, the position of the SEMS was stabilized. The patient remained stable with adequate oral intake.

Topics: Aged, 80 and over; Bronchial Fistula; Esophageal Fistula; Humans; Male; Quality of Life; Retrospective Studies; Silicon; Silicones; Stents; Treatment Outcome

Silicon and metallic are two types of stents in use. In this study, we compared complications and long-term survival among patients who received silicon or fully covered, bifurcated self-expandable metallic stents (SEMS) for a malignant tracheobronchial obstruction and/or tracheo/bronchial oesophageal fistulas.. Patients in whom Y-shaped stents were used from January 2013 to June 2017 in our interventional pulmonology unit were evaluated retrospectively from patient files.. Of the 47 patients, 30 (23 males, 76.7%) were in the silicon stent group and 17 (14 males, 82.4%) were in the covered SEMS group. No differences between the groups were detected in ECOG status, pathological properties of the disease, radiotherapy or chemotherapy history before the procedure, symptoms at presentation, or comorbidities. The most common symptom was dyspnoea (96.7% and 100%), and the most common comorbidity was chronic obstructive pulmonary disease (26.7% and 23.5%). A total of 20 complications (42.6%) were seen, with no significant difference between the groups (silicon, 40%; SEMS, 47.1%; P = . 62). Mean survival was 164.51 ± 38.83 days for the silicon stent group and 254.45 ± 103.32 days for the SEMS group (P = .588). No differences were observed in 30-, 90- or 180-day mortality between the two groups (P = .966, .846 and .534, respectively).. No significant differences in symptom palliation, insertion safety, complication rate or survival were detected between the two types of stent.

Topics: Airway Obstruction; Bronchial Fistula; Bronchoscopy; Case-Control Studies; Comorbidity; Dyspnea; Female; Humans; Male; Neoplasms; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Safety; Self Expandable Metallic Stents; Silicon; Stents; Survival Analysis; Treatment Outcome

Patients with head and neck cancers often require use of a tracheal cannula due to stenosis of the permanent tracheostoma following total laryngectomy. However, a cannula that is designed for a multi-purpose tracheotomy frequently presents a problem, when placed in a permanent tracheostoma. To resolve this difficulty, we developed a straight cannula that fits most permanent tracheostomas. We achieved a straight design by removing the curvature of a cuffed tracheostomy single cannula (size 12: Koken Co., Ltd.). To facilitate installation by the patient without assistance, silicone was used because it is softer than similar conventional products. By making the cannula diameter slightly larger, immobilization with a strap is lomger needed. Our cannula was used in 14 patients following surgery for the laryngeal, hypopharyngel, esophageal carcinomas. The cannula fit well and reduced the respiratory discomfort in all patients.

Topics: Aged; Aged, 80 and over; Brachiocephalic Trunk; Bronchial Fistula; Catheterization; Equipment Design; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Silicon; Trachea; Tracheostomy