Endoscopic dilation of acquired tracheobronchial stenosis in infants

Abstract

Acquired tracheobronchial strictures in infants are associated with significant morbidity. Their treatment requires different types of therapeutic procedures depending on the severity and location of the stenosis. We successfully dilated five children (ages between 1 and 23 months) with acquired tracheobronchial (stenoses two carinal and three of the mainstem bronchi) using a new technique. Gruentzig balloon catheters of different caliber were introduced into the tracheal lumen of apneic children under endoscopic vision. Three infants required four dilations and in the other two cases only two procedures were necessary. One complication occurred during dilation and resulted in a pneumothorax caused by a partial bronchial disruption. At follow‐up (range, 18–36 months; mean, 23.4 months) all five children were clinically improved. In the four cases without complications the chest x‐rays were normal and the last bronchoscopy showed tracheobronchial trees with normal calibers. The child who developed a pneumothorax during attempted dilation recovered. In this child, dilation of the right upper lobe bronchus was unsuccessful. Dilation was attempted without visualization of the bronchus and the stricture. Our limited experience confirms that pneumatic balloon catheters can successfully treat acquired tracheobronchial stenoses in infants. To avoid complications, strict criteria need to be applied in the selection of cases with tracheobronchial stenoses. Pediatr Pulmonol. 1997; 23:101–104. © 1997 Wiley‐Liss, Inc.

ERS statement: interventional bronchoscopy in children

“…Muscle relaxation is not essential, but is preferable to avoid coughing with an inflated balloon in the airway, which might cause dislodgement of the balloon, pneumothorax or airway rupture [89]. In children, angioplasty balloon catheters are most widely used since they impart a radially directed force against the airway lumen, which is less traumatic to the mucosa than a bougie [86,90,91]. Tracheobronchography with small volumes of contrast agent can be performed to assess the location, length and diameter of the stenosis [92].…”

Successful management of acquired left bronchial stenosis caused by massive atelectasis

“…1 Intrinsic acquired bronchial stenosis such as granuloma or fibrotic stenosis could be managed with endoscopic dilation or laser resection. 6–12 However, endoscopic dilation or laser resection was not indicated in this case because the bronchial stenosis was due to compression by the descending aorta. Correcting the condition of atelectasis caused the bronchial stenosis to heal, and surgical treatment of the bronchial stenosis could be avoided.…”

Technique, Utility, and Safety of Awake Tracheoplasty Using Combined Laser and Balloon Dilation

“…Balloon dilation tracheoplasty was pioneered by Cohen et al, who adapted previously described angioplasty techniques to the lower airway 8 . This technique has been further modified by a variety of authors with varying success 9–11 . It is likely that the radial pressure exerted by the balloon in opening an airway is less damaging to the tracheal wall mucosa in comparison to passing a rigid dilating instrument along the tracheal‐long axis and creating unnecessary injury to the surrounding healthy mucosa.…”