Tracheobronchial stent sizing and deployment practices airway stenting practices around the world: a survey study
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Background: Tracheobronchial stents types, uses, techniques for deployment and extraction have practice variations around the world. Methods: We collected responses by sending an online survey of 8 questions to world interventional bronchology member societies and social media groups. Results: There were 269 respondents from 47 countries. Europe had 97 respondents from 22 countries. There were 8 respondents from Australia, 7 from Africa (3 countries) and 7 from 4 countries in South America (SA). North America (NA) had 72 respondents from 3 countries. Asia had 78 respondents from 14 countries. For stent placements 15%  used fiberoptic bronchoscope (FB) only. Rigid bronchoscopy (RB) was solely utilized by 38% . Forty-six percent  used a combination of RB and FB (P value <0.00001). For stent extraction 13%  used FB alone, 57%  used RB, and 36%  used a combination of RB and FB (P value <0.00001). Placement of stents were 50.5%  only by direct visualization. Twenty-three percent  always used fluoroscopic guidance. Twenty-six-point-five percent  used fluoroscopy in certain cases (P value <0.00001). Sixty percent  decided stent sizing by measurements of stenotic and non-stenotic areas on radiology. Twelve percent  respondents used sizing devices. Sixty-five percent  used a ruler and bronchoscope to measure stenotic areas. Thirty-eight percent  used visual estimation and experience. Seven percent  used serial balloon dilatation size. To prevent clogging of stents, 22%  prescribed mucolytics. Seventy-three percent  nebulized saline, 26%  had Mucomyst Nebulization, 24%  Nebulized bronchodilators and other methods 11%  were advised. Covered self-expandable metal stents (SEMS) 44% was the commonest type of stent used around the world. Silicone stents 37%, Y stents 15%, uncovered SEMS 12%, Montgomery T tube 5% followed. Polyflex stents 3% and custom-made stents 3% were least used. Biodegradable stents were used by 7.5%, and not used by 92.5%. Conclusions: Tracheobronchial stent practice norms have slowly evolved, but its practice variations lack uniformity, and have sparse evidence-based studies for its direction.