Use of endoscopically placed expandable nitinol tracheal stents in the treatment of tracheal stenosis.

OBJECTIVE: To evaluate the potential utility of a new endoscopically placed expandable tracheal stent in the treatment of benign symptomatic stenoses of the cervical trachea. STUDY DESIGN: Pilot study utilizing a prospectively followed case series. METHODS: An initial group of six patients undergoing stent placement was examined with rigid and flexible endoscopy under anesthesia immediately following stent placement and at postoperative 6 to 8 weeks. Subsequently each patient was followed clinically for a minimum of 6 months. RESULTS: All stents were well tolerated with no observed complications. Immediate reversal of symptomatic airway obstruction without the need for adjunctive tracheotomy was noted in every patient. At 6 weeks, endoscopic confirmation of complete intraluminal mucosalization without formation of any granulation tissue or scar bands within the stented areas was noted in each case. CONCLUSIONS: This preliminary pilot study supports the use of nitinol expandable tracheal stents as an alternative in the treatment of benign symptomatic tracheal stenoses.

Surgical management of complications of endoscopic sphincterotomy with precut papillotomy.

We reviewed 574 endoscopic sphincterotomy procedures. Fifty-six precut papillotomies were performed. Presenting conditions included choledocholithiasis, cholangitis, benign and malignant papillary strictures, and stenosing papillitis. Complications were identified in 16 percent: perforation in 9 percent, pancreatitis in 5 percent, bleeding in 2 percent, and pancreatic abscess in 2 percent. One patient died. Six patients required operation for complications. Perforation of the duodenum or common bile duct seen within 8 hours was managed with drainage and closure of the perforation with minimal complications. Duodenal perforations operated on later than 8 hours required more extensive procedures. All these patients had significant post-operative complications. Three patients were managed nonoperatively. Precut papillotomy carries a significantly higher complication rate than conventional sphincterotomy. Our experience suggests that there is no place for conservative management of duodenal perforation.