Bronchoscopy Stent Placement cost in India

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What is Pulmonary or Bronchial Stent?

A pulmonary stent can provide immediate relief of symptoms and improvement in pulmonary function for both intrinsic and extrinsic airway lesions. Tracheo-bronchial stenting procedures are being employed with increasing frequency. The practicing anesthesiologist must be familiar with the management of patients undergoing airway stenting procedures.

Why is it used?

• Airway stents can be permanent or removable
• They can be used after your pulmonary physician applies laser, electrocautery, balloon dilatation, or APC to increase the size of airway narrowing
• By placing a stent, the airways remain open, allowing adequate airflow and the normal passage of secretions.

Benefits of Tracheobronchial Stents

• Stents vary in rigidity
• Body of the stent helps resist compression from the airway tissues
• They allow airways to remain open and keeps the lung from becoming collapsed

Types of Stents:

Silicone stents:

Silicone, a synthetic substance made of silicone elastomers, is firm and stable at high temperatures. Several tracheobronchial silicone stents are commercially available including the Dumon, Polyflex, Noppen, and Hood stents. The benefits of silicone stents over metallic stents include relative ease of removal and replacement, lower cost, and no tumor invagination. Disadvantages of silicone stents include their tendency to migrate and induce granuloma formation, insufficient flexibility to conform to irregular airways, higher rate of mucostasis, lower inner to outer diameter ratio, and the need for rigid bronchoscopy for placement.

Metallic stents:

The first generation airway metallic stents (Gianturco, Strecker, and Palmaz) were uncovered, rigid, non-conforming, stainless steel stents associated with an increased incidence of airway and vascular erosion. The second generation Wallstent and Ultraflex stents are available in both covered, partially and uncovered varieties while the Aero stent is a nitinol stent fully covered in polyurethane. All metallic stents are radiopaque, and exhibit varying degrees of dynamic expandability. When uncovered, metallic stents maintain ventilation and some ability to evacuate secretions if placed over lobar orifices.

Metallic stents include fixed-diameter stents, which require balloon dilatation, and self-expandable stents, which “spring” to a predetermined diameter once released. The stents are made of bare metal or have a thin coating of silicone, nylon, or polyurethane.

Metallic stents have gained popularity because of their ease of insertion. In addition, they may be placed in an outpatient setting via flexible bronchoscopy under local anesthesia. Other advantages of metallic stents over silicone stents in management of tracheobronchial obstruction include thinner walls, decreased migration and their ability to conform to tortuous airways. Similar to the silicone stents, however, metallic stents may induce granulation tissue formation. Other disadvantages are difficulty in removal, potential for wire fracture, increased expense, tumor invigilation if not coated, and increased risk of perforation and erosion.

Choice of Stent:

Proper selection of stent type and size is critical to avoiding stent-related complications, including migration, granulation tissue formation, and airway perforation from excessive radial force of the stent. Proper choice of a stent should not be based on ease of placement but rather the best stent for a given condition. For benign strictures, only silicone stents should be used, as they are easy to remove and replace.

A useful “check list” of questions when considering stent placement includes:

• Is a stent required?
• Will the patient benefit from stent placement in terms of quality of life or prognosis?
• Is there expandable lung distal to the obstruction?
• Will the stent interfere with or prohibit a curative surgical procedure in the future?
• Does the operator have the expertise, equipment, and team to place the stent?
• What is the underlying airway pathology and which stent is ideal for that pathology?
• Is it safe to place a stent in the anatomic site?
• What are the required stent dimensions (length and diameter)?
• Does the operator have the optimal stent, or should a more appropriate one be obtained?

During Procedure

Bronchoscopy should be performed in patients with symptoms or radiographic findings suggestive of central airway obstruction. When a stenosis is discovered the length and diameter of the lesion should be documented. A spiral CT scan with three-dimensional reconstruction is extremely helpful in the sizing of the stent needed. If a lesion is not amenable to endoscopic removal, bronchial dilatation should be done to enable insertion of a stent of the appropriate diameter.

Silicone stents are placed through a rigid bronchoscope using a specially designed stent deployer. Metallic stents can be placed with a flexible or rigid bronchoscope, using either a guidewire, direct visualization or an over the scope system, depending on the particular type of stent.

Risks Involved in Procedure

The most common complications are tumor in-growth, stent fracture, infectious tracheobronchitis, mucostasis, and obstructing granuloma. For obstruction by granuloma and tumor in-growth, endoscopic removal by laser, cryotherapy, or argon plasma coagulation may be required. Respiratory infections have been shown to increase the risk of granulation tissue formation following airway stenting in patients with malignant airway obstruction. Stents are also associated with increased risk of respiratory infections in patients undergoing airway interventions for malignant airway disease.