Factors Leading to Obstructive Granulation Tissue Formation after Ultraflex Stenting in Benign Tracheal Narrowing

Abstract

Background: This retrospective study aimed to determine the factors leading to obstructive granulation tissue formation after the placement of a self-expandable metallic stent (SEMS) in patients with benign tracheal disease. Methods: From 2001 to 2007, a total of 67 patients (age: 62.1 ± 15.4 years; range: 23–87 years) with benign tracheal disease received 75 ultraflex SEMS in our institution. Results: There were 35 SEMSs complicated by obstructive granulation tissue formation out of the 75 stents placed in patients with tracheal disease, giving an incidence of 47.8 % (32/67 patients). The median time until developing granulation tissue was 106 days (IQR, 46–396). Structural airway obstruction prior to SEMS implantation independently predicted obstructive granulation tissue formation after SEMS implantation (odds ratio: 3.84; 95 % CI: 1.01–8.7; p = 0.04). Time to granulation tissue detection was shorter in patients with structural airway obstruction before SEMS implantation (structural airway obstruction vs. dynamic collapse airway: median [IQR] 95 [38–224, n = 26] vs. 396 days [73–994, n = 9]; p = 0.02). Conclusions: Obstructive granulation tissue formation is not uncommon after SEMS implantation and structural airway obstruction prior to SEMS implantation is an independent predictor. Although SEMS implantation should be restricted to a select population, it may be placed in patients not suitable for surgical intervention or rigid bronchoscopy with anesthesia because of poor pulmonary function.

Key words

self‐expandable metallic stents - obstructive granulation tissue - benign tracheal stenosis - ultraflex

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