We report a new way of managing the airway compromise which can occur after placement
of an esophageal self-expanding metal stent (SEMS) [1 2 3 4 5
A 48-year-old man with an inoperable esophageal malignancy was referred for stenting.
After dilation, with Savary-Gilliard dilators up to 12.8 mm, the extent of the tumor
was revealed to be from 20 to 30 cm from the incisors. A 15-cm covered SEMS (Microvasive,
Boston Scientific Corporation, Watertown, Massachusetts, USA) was deployed. The patient
developed stridor 30 minutes later. Intravenous hydrocortisone 100 mg was administered
and stent removal was planned. The stridor stopped during the attempt to remove the
stent, and therefore the stent was not removed. However, stridor recurred 36 hours
later,. A tracheostomy was created, and bronchoscopy through the tracheostomy tube
revealed tumor infiltration of the posterior wall of the trachea up to the carina,
and extrinsic compression of the trachea from just beyond the tracheostomy tube for
2 - 3 cm. The patient could not afford a metallic tracheal stent. The tracheostomy
tube was not long enough to bypass the luminal narrowing, hence a size 7 endotracheal
tube was inserted through the tracheostomy site (Figure [1
Options for managing respiratory compromise after esophageal SEMS insertion include
the following: stent removal [1 2 4 5 3
Figure 1 Chest radiograph shows the endotracheal tube which was inserted through the tracheostomy
site
