TABLE 1.

Summary of interventional bronchoscopy techniques available for the management of malignant central airway obstruction

Studies	Anaesthesia	Principle	Indication	Advantages	Drawbacks
Mechanical debulking	General	Resection with the rigid tubes and forceps	Proximal, slightly haemorrhagic, and intraluminal lesions	Rapidity Cost	Severe complications in 20% (bleeding, perforation)
Laser	General anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure time	Short pulsations in the bronchial axis at 30–50 W Flexible or rigid bronchoscope	Intraluminal or mixed critical proximal obstructions	Immediate and prolonged debulking Few complications if trained operator	Cost Risk of perforation and bronchovascular fistula
Thermo-coagulation/argon plasma coagulation (APC)	General anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure time	High-frequency electric current ± argon as a carrier gas (APC)	Intraluminal or mixed proximal obstructions	Immediate efficacy Cost Low risk of perforation APC: treatment of extended and haemorrhagic lesions	Risk of scarring stenosis if circumferential treatment
Cryotherapy	General anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure time	Expansion of a cryogenic gas Cycles of rapid freezing and slow thawing	Non-critical exophytic malignant obstructions	Low cost Easy procedure No perforation Prolonged efficacy Synergistic action with chemotherapy	Delayed effect (except cryoextraction and spray cryotherapy) Need for a second cleaning bronchoscopy
Photodynamic therapy	General anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure time	Activation of a photosensitiser by light	Non-critical exophytic malignant obstructions	Good symptom control (haemoptysis) Prolonged efficacy	Delayed effect Retention of tumour material Cleaning bronchoscopy Phototoxicity Constraining technique Haemorrhagic complications
Silicone stent	General	Placed using a prosthesis pusher inserted in the rigid tube	Extrinsic or mixed compressions	Good tolerance Few local granulomatous and ischaemic reactions Easily removable	Altered ciliary clearance Risk of migration (rare, except in cases of purely extrinsic compression)
Metallic stent	General anaesthesia and rigid bronchoscopy highly recommended	Self-expandable Placed using a guide wire under radiographic or bronchoscopic control Flexible or rigid bronchoscopy	Second line; not to be considered as a first choice, except in cases of highly necrotic lesions or large distortion	Easy placement Possible with flexible bronchoscope (but should be avoided if rigid tube is unavailable) Preserved clearance	Frequent complications (granuloma, perforation, rupture) Hardly removable