Metal stenting as first-line therapy for tracheal compression after gastric pull-up.

I read with interest the report on the treatment of tracheal compression due to a gastric pull-up by Kim et al (March 2002).1 The patient was treated with metal stenting for this condition, with improvement as expected. However, I am somewhat puzzled about the metal stent as a first-line treatment. As stated in the report, metal stents have significant potential for complications, especially in patients with a long life expectancy, as is the case in most benign obstructive airway disorders. Many of these complications are easily dealt with, but some can lead to disabling morbidity. No mention is made in the report about alternative options such as silicone stenting or surgical correction. The stent manufacturer, as well as many interventional pulmonologists, recommends to use only metal stents in benign disease if all other options have failed. By description, the patient in the study by Kim et al could have been a candidate for other interventions. If this is the case, it would have been necessary to inform the patient about the “off-label” use of the stent as well as about alternative options, such as stenting with a silicone endoprosthesis.