Abstract
<title>Abstract</title> <p>Background Tracheo-esophageal fistula (TOF) is a life-threatening complication of malignant and benign airway disorders, requiring urgent palliation. Airway stenting provides rapid symptom relief. Although rigid bronchoscopy is the conventional technique, flexible bronchoscopy (FOB) is emerging as a versatile and less resource-intensive alternative. Objective To evaluate the indications, procedural characteristics, short-term outcomes, and complications of FOB-guided airway stenting — including tracheoesophageal fistula, benign stenosis, and malignant airway obstruction — at a high-volume tertiary centre. Methods This retrospective observational study included 38 consecutive patients who underwent tracheal or bronchial stenting between April 2021 and May 2025. All stents were covered self-expandable metallic stents (SEMS) deployed using flexible bronchoscopy. Results Mean age 55.4 years; 57.9% male. Malignant TEF was the most frequent indication (73.7%, n = 28). Tracheal stents were most common (65.8%). Procedures were performed in non-intubated (60.5%), intubated (31.6%), and tracheostomised (2.6%) patients. Twenty-seven patients (71.0%) had an uneventful course. Stent migration was the most frequent complication (13.2%). Forty-seven percent were discharged home with symptom improvement. One death occurred from underlying disease; no procedure-related mortality. Conclusions In this single-centre retrospective series, FOB-guided airway stenting was technically feasible with 100% procedural success and was associated with meaningful short-term clinical improvement in selected patients. These findings support its clinical utility where rigid bronchoscopy is unavailable or contraindicated, but do not permit definitive conclusions regarding safety equivalence. Prospective comparative studies are required.</p>