Edell, Eric

Background: Airway stenting is a critical intervention to restore airway patency, yet complications such as stent migration, mucostasis, airway injury, and granulation tissue formation remain major concerns. Although various covering materials have been explored, the effectiveness of amniotic membrane (AM) as a stent cover has not been evaluated. This study is the first to assess airway-related complications of a novel AM-covered self-expandable metallic stent (SEMS) compared with a commercially available synthetic polymer-covered SEMS. To compare the incidence of stent-related complications between AM-covered SEMS and synthetic polymer-covered SEMS over a 90-day in vivo survival period. Methods: Eight adult Yucatan miniswine were implanted with either an AM-covered or control stent and monitored over 90 days with bronchoscopic evaluations at 4 timepoints. Histologic assessments were performed at termination. Results: Seven animals completed the study (4 AM stents, 3 controls). One control animal was terminated early due to stent expectoration. AM-covered stents were associated with reduced stent migration, mucostasis, and granulation tissue formation compared with controls. Histologic analysis revealed significantly less airway injury and evidence of re-epithelialization with cilia in the AM group; a feature absent in control stents. One animal was excluded at implantation and replaced due to a procedural complication unrelated to the stent. Conclusion: This is the first study to evaluate stent-related complications of AM-covered airway stents. The results demonstrate that AM-covered SEMS reduce airway injury and common complications associated with synthetic polymer-covered stents. These findings suggest that AM-coverings may enhance biocompatibility and integration while mitigating adverse airway responses. Larger studies and human clinical trials are needed to validate these results and explore clinical application.

ABSTRACTObjectiveThere is currently not a marker of disease severity in idiopathic subglottic stenosis (iSGS). Our objective was to characterize iSGS patients' disease severity using endoscopic surgery rates.MethodsThis was a two‐center retrospective analysis of iSGS patients with a minimum of 4 years of follow up following an initial endoscopic procedure (laser wedge excision (LWE) or endoscopic dilation (ED)). Disease severity was classified into Groups A–C, based on whether patients had fewer (Group A), the same number (Group B), or more surgeries (Group C) in years 3–5 compared to years 1 and 2. Disease severity proportions were compared across institutions using chi‐square analysis. Nonparametric testing compared clinical characteristics such as age, BMI, and GERD across severity groups.ResultsThere were 104 patients from institution 1 and 53 patients from institution 2 that were all female and predominantly Caucasian. Both institutions had clinically and statistically similar proportions of patients in Group A (64% vs. 62%), Group B (20% vs. 19%), and Group C (16% vs. 19%) disease (p > 0.05). No clinical characteristic (e.g., age, sex, race, BMI, GERD) was associated with disease severity.ConclusionAcross tertiary care institutions there is a consistent proportion of iSGS patients who either demonstrate nonrecurrent/decelerating (Group A), stable but persistent (Group B), or rapidly recurring disease (Group C). Two‐year surgery rates appear to be an important timepoint for providing expectations to patients on the likelihood of possessing severe disease.Level of Evidence4

ABSTRACTObjectiveWhile endoscopic laser wedge excision (LWE) for iSGS demonstrated lower surgical recurrence rates compared to endoscopic dilation (ED), ED remains the primary technique employed. Additionally, serial intralesional steroid injections (SILSIs) also demonstrate benefits in controlling disease. We aimed to compare surgical recurrence rates following ED, ED + SILSI, and LWE following a patient's first operation.MethodsThis was a two‐center retrospective analysis of iSGS patients who underwent either ED, ED + SILSI, or LWE. Patients were followed to their last follow‐up date or reoperation. Kaplan–Meier analysis and Cox proportional hazards were used to evaluate the recurrence times across the different surgical groups with additional stratification by age, compliance to medical adjuvant therapy, and percentage of stenosis rated at reoperation.ResultsA total of 126 patients from Institution 1 underwent LWE, while at Institution 2, ED and ED + SILSI were performed on 32 and 23 patients, respectively. One‐year recurrence estimates were 9%, 53%, and 0% for LWE, ED, and ED + SILSI, respectively, while 5‐year recurrence estimates were 45%, 90%, and 19%, respectively. Adjusted Cox‐proportional hazard ratios demonstrated a greater risk of surgical recurrence with ED compared to LWE (2.25; 95% confidence interval [CI]: 1.31–3.88) and no difference between ED + SILSI and LWE (0.84; 95% CI: 0.32–2.25).ConclusionLWE demonstrates reduced recurrence times compared to ED when controlling for surgery number, age, triple therapy compliance, and percentage of stenosis at reoperation. The application of postoperative SILSI appears to similarly reduce recurrence rates comparable to LWE and warrants further investigation.