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.