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Endobronchial Therapy : Stents and Stunts

Endobronchial Therapy : Stents and Stunts. Prof Mordechai Kramer Rabin Medical Center Petach-Tikva Israel. at RMC Bronchoscpies. Endoscopic paliation. Relief of Airway obstruction: Laser Brachytherapy Stenting Single Multiple Balloon dilatation Closure of fistula.

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Endobronchial Therapy : Stents and Stunts

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  1. Endobronchial Therapy: Stents and Stunts Prof Mordechai Kramer Rabin Medical Center Petach-Tikva Israel

  2. at RMCBronchoscpies

  3. Endoscopic paliation • Relief of Airway obstruction: • Laser • Brachytherapy • Stenting • Single • Multiple • Balloon dilatation • Closure of fistula

  4. Brachytherapy • 1921-Yankaur Radon 222 seeds • 1961-Pool Ra 222- • 1965- Johnston, Gibbons Au 198 • 1979- Mittal -Brachytherapy with FOB • 1984-Percarpio - Ir 192 afterloading

  5. Brachytherapy-Technique • Outpatient basis • Short, mild sedation • HDR delivery system • Two/Three sessions 7-14 days apart • 500-750 Rads (1500-2250 total)

  6. Indications • Malignant • Primary lung malignancy • Secondary metastasis • Benign • Granulation tissue • Stents • Transplantation

  7. Brachytherapy-Indications • Trachea and major airways • Endobronchial involvement • Can be added to laser/stents/balloon dilatation • Can be added to external beam radiation and chemotherapy

  8. Brachytherapy Vs. Laser therapy • Brachytherapy • Slow action • Deeper and wider action • Requires lumen for catheter • Short procedure • Laser • Rapid action • Superficial action • Creates lumen • Bleeding control • Sometimes prolonged procedure

  9. 57 Y Female CarinalAdenoca

  10. Laser effect

  11. 76 Y Male NSCCa

  12. Brachytherapy-Results • Complete airway opening-42% • Partial opening- 36% • Failure- 22% • Significant palliation • Effect on survival??

  13. Brachytherapy is an easy, safe and effective modality for palliation of malignant airway obstruction • Brachytherapy can be added to either local and/or systemic modalities • Brachytherapy may have some effect on survival • Brachytherapy can be used safely in non-malignant condition, albeit longer follow up is needed Conclusions

  14. AirwayStenting

  15. - אמת או שקר Laser Vs Stent • LASER is an acronym for light amplification by stimulated emission of radiation • Stents were invented in 1856 by the English dentist Charles Stent (1807–1885) • לייזר פיירמן המציא את שיטת הלייזר בשנת 1960 • שיטת הסטנט הוכנסה לשימוש עי John Holder בשנת 1988

  16. Rt bronchus Intermediustumor

  17. Airway Stenting- Indications • Malignant • Bronchogenic carcinoma • Metastatic tumor • Direct invasion- Thyroid, Esophageal etc • Compression of airways by nearby tumor

  18. Stent types • Metal • Silicon

  19. 55 y Female NSCCa RLL

  20. 55 y Female NSCCa RLL

  21. 6 months later

  22. Tracheal Tumor

  23. Carinaltumours

  24. Double stent with Rt main hole

  25. Solution: 2 stents with hole to RT main

  26. Stenting is a viable option in malignant stenosis Technically, stenting is easy to perform with experienced team Combination therapy with laser and radiotherapy is commonly used Summary

  27. Balloon dilatationRt main

  28. Carcinoid Resection

  29. 22y f recurrent pneumonia

  30. 6 weeks later

  31. 3 months later

  32. 6 months later

  33. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. Palliation

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