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Early Stent Removal Using Topical Mitomycin C in Patients with Bronchial Stenosis
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A3163 - Early Stent Removal Using Topical Mitomycin C in Patients with Bronchial Stenosis
Author Block: C. Kim1, Y. Ko2, H. Nam3, G. Seong4; 1Department of Internal Medicine, Jeju National University Hospital, Jeju-si, Korea, Republic of, 2Hallym University Kangdong Sacred Heart Hospital, SEOUL, Korea, Republic of, 3Department of Internal Medicine, Inha University Hospital, Incheon-si, Korea, Republic of, 4Jeju National University Hospital, Jeju-si, Korea, Republic of.
Silicon stent insertion is a useful treatment for benign tracheobronchial stenosis. Nevertheless, there is no consensus defining the optimal timing of its removal. In the previous reports, it is recommended that stents should be placed for at least 6 to 18 months in benign airway stenotic cases. However, stent related long-term complications such as migration, mucus impaction, and granulation tissue formation are not uncommon. Topical application of mitomycin C (MMC), which inhibits fibroblast proliferation and modulates wound healing and scarring, could be a promising adjuvant therapeutic modality. We present two cases of benign bronchial stenosis that were successfully treated by mechanical dilatation with topical MMC application and short-term placement of silicon stent. A 57 year old female was referred because of cough and dyspnea on exertion for more than one year. Bronchoscopy revealed a tight, slit-like stenosis in the left main bronchus. The FEV1 was 1.46 (63% of predicted). After mechanical dilatation with a rigid bronchoscope, MMC (0.4 mg/mL) was applied circumferentially, and then a Dumon stent (10 mm outer diameter, 3.9 cm length) was inserted. The stent was removed in 4 months, and her bronchus was patent without restenosis. The FEV1 increased to 1.94 (84% of predicted) in a month. She has remained stable without symptoms of recurrence. A 43 year old female was referred to our center due to post-tuberculosis bronchial stenosis. The FEV1 was 2.33 (77%). Bronchoscopy revealed a pinpoint narrowing of the right bronchus intermedius. After mechanical dilatation using a rigid bronchoscope, MMC (0.4 mg/mL) was applied over the area of stenosis, and then a Dumon stent (10 mm outer diameter, 3.5 cm length) was inserted. After 3 months, the stent was removed. The FEV1 increased to 2.72 (90%) in a month after stent removal. She has also remained stable without a recurrence. Topical application of mitomycin C may facilitate earlier removals of bronchial stents and prevent restenosis in patients with benign bronchial stenosis.
Author Block: C. Kim1, Y. Ko2, H. Nam3, G. Seong4; 1Department of Internal Medicine, Jeju National University Hospital, Jeju-si, Korea, Republic of, 2Hallym University Kangdong Sacred Heart Hospital, SEOUL, Korea, Republic of, 3Department of Internal Medicine, Inha University Hospital, Incheon-si, Korea, Republic of, 4Jeju National University Hospital, Jeju-si, Korea, Republic of.
Silicon stent insertion is a useful treatment for benign tracheobronchial stenosis. Nevertheless, there is no consensus defining the optimal timing of its removal. In the previous reports, it is recommended that stents should be placed for at least 6 to 18 months in benign airway stenotic cases. However, stent related long-term complications such as migration, mucus impaction, and granulation tissue formation are not uncommon. Topical application of mitomycin C (MMC), which inhibits fibroblast proliferation and modulates wound healing and scarring, could be a promising adjuvant therapeutic modality. We present two cases of benign bronchial stenosis that were successfully treated by mechanical dilatation with topical MMC application and short-term placement of silicon stent. A 57 year old female was referred because of cough and dyspnea on exertion for more than one year. Bronchoscopy revealed a tight, slit-like stenosis in the left main bronchus. The FEV1 was 1.46 (63% of predicted). After mechanical dilatation with a rigid bronchoscope, MMC (0.4 mg/mL) was applied circumferentially, and then a Dumon stent (10 mm outer diameter, 3.9 cm length) was inserted. The stent was removed in 4 months, and her bronchus was patent without restenosis. The FEV1 increased to 1.94 (84% of predicted) in a month. She has remained stable without symptoms of recurrence. A 43 year old female was referred to our center due to post-tuberculosis bronchial stenosis. The FEV1 was 2.33 (77%). Bronchoscopy revealed a pinpoint narrowing of the right bronchus intermedius. After mechanical dilatation using a rigid bronchoscope, MMC (0.4 mg/mL) was applied over the area of stenosis, and then a Dumon stent (10 mm outer diameter, 3.5 cm length) was inserted. After 3 months, the stent was removed. The FEV1 increased to 2.72 (90%) in a month after stent removal. She has also remained stable without a recurrence. Topical application of mitomycin C may facilitate earlier removals of bronchial stents and prevent restenosis in patients with benign bronchial stenosis.
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