Retrievable covered metallic segmented Y airway stent for gastrorespiratory fistula of carina or main bronchi

Abstract

Objective

To evaluate the feasibility of new retrievable covered metallic segmented Y airway stents modified with 3-dimensional (3D) printing for gastrorespiratory fistula involving carina or main bronchi.

Methods

We designed a new retrievable covered metallic segmented Y airway stent to fit the anatomical characteristics of the carina region in individual patients. All stents were individually customized based on a 3D-printed mold. Six patients with gastrorespiratory fistula and aspiration pneumonia after esophagectomy underwent the stent implantation. The stents were retrieved when the fistula was cured or stent-related complications occurred.

Results

Seven Y stents were successfully implanted and removed in 6 patients. All stents expanded well, and the fistulas were completely sealed. Aspiration pneumonia was controlled in 6 patients. The median Karnofsky Performance Status scores significantly improved after stenting compared with those before stent implantation (P = .024). Sputum retention was the most common complication after stenting and was treated with aspiration under bronchoscopy (33.33%). Excessive granulation tissue proliferation was found in 1 patient (16.7%) and was treated with cryotherapy. The indwelling time of the stent was 64 days (interquartile range, 52-69 days). After stent removal, bronchoscopy, gastroscopy, and computed tomography of the chest showed cured fistulas in all patients, and no stents showed fractures.

Conclusions

Retrievable covered metallic segmented Y airway stents modified with 3D printing appear to be feasible for the treatment of gastrorespiratory fistula involving carina or main bronchi.