Evidence against routine scheduling of surveillance bronchoscopy after stent insertion

STUDY OBJECTIVES: To determine whether routine scheduling of surveillance flexible fiberoptic bronchoscopy is warranted within 2 to 3 months after silicone stent insertion for central airway obstruction. DESIGN: Retrospective cohort study. SETTING: University medical center. PATIENTS: All patients with silicone stents placed for benign or malignant tracheobronchial obstruction during a 3-year period. METHODS: Incidence of stent-related complications, new respiratory symptoms, and need for therapeutic bronchoscopic intervention were noted in patients undergoing surveillance bronchoscopy (SFFB) and emergency bronchoscopy (EFFB), defined as flexible fiberoptic bronchoscopy prompted by onset of new symptoms before the date of scheduled SFFB. RESULTS: One hundred one silicone stents were inserted in 88 patients (47 with cancer, 41 with benign disease). Eighteen patients died within 2 months and had no bronchoscopy. Seventy patients underwent either SFFB or EFFB. Stent-related complications were detected in 9 of 31 asymptomatic patients (29%) undergoing SFFB; all had received tumor-specific therapy after stent insertion (in 7 of 8 patients 88%] reporting new respiratory symptoms at the time of SFFB, and in 26 of 31 patients 84%] undergoing EFFB). Overall, stent-related complications were detected in nine asymptomatic patients (10% of total), of which only four patients (5% of total, but 13% of all asymptomatic patients) required therapeutic interventions. CONCLUSION: Routine SFFB within 2 to 3 months after stent insertion did not detect a high incidence of stent-related complications among patients without new respiratory symptoms.