Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients

Abstract

BackgroundManagement of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment.MethodsPatients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation.ResultsA total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions.ConclusionsBTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising.

Palliative Therapy with Argon Plasma Coagulation in Post-Intubation Tracheal Stenosis

“…Therapeutic bronchoscopic modalities include balloon dilatation, laser, APC, electrocauterization, cryotherapy, stent placement, endobronchial chemotherapy and brachiotherapy [28][29][30][31]. When therapeutic bronchoscopy is compared with surgical therapy it is more comfortable and less risky for the patients [6].…”

Interventional management of tracheobronchial strictures

“…The balloon dilates the stenotic trachea or bronchus by stretching and expanding the bronchial wall, making balloon dilation appropriate for the treatment of cicatric annular strictures. Balloon dilation has been extended to the treatment of tracheobronchial stenoses due to, for example, post-intubation tracheal stenosis, postoperative anastomotic stenosis, granulomatous steno-sis (tuberculosis, histoplasmosis), radiation therapy, mediastinal fibrosis, congenital stenosis, bronchial trauma and bronchial artery embolization [2][3][4][5] . Before balloon dilation, the site, severity, proximal and distal extent, and characteristics of the stricture should be evaluated by conventional radiography, computed tomography scans including threedimensional reconstructions, and/or bronchoscopy.…”

“…A review of several representative studies, each including 21-59 patients [2,3,[5][6][7] , found that the technical success rate was 100% and that all patients achieved initial symptomatic improvement. In some of these studies, however, up to 80% of patients required adjuvant treatment, including stent placement and laser therapy [2,3,[5][6][7] .…”

“…In some of these studies, however, up to 80% of patients required adjuvant treatment, including stent placement and laser therapy [2,3,[5][6][7] . Complications associated with balloon dilation include chest pain during dilation, bronchospasm, atelectasis after dilation, superficial or deep mucosal laceration, pneumomediastinum, and massive bleeding have been reported [3,[8][9][10] .…”

“…Recently, cutting balloon dilation has shown much better patency, approximately 60% at 2 years, for the treatment of benign bronchial strictures resistant to conventional balloon dilation [4] . Endobronchial brachytherapy may be used to treat benign bronchial strictures resistant to conventional balloon dilation or as an adjuvant treatment to treat granulation tissue formation after airway restoration [5,11] . Tracheobronchial balloon dilation is a simple, rapid, and safe method of restoring airway lumen, providing immediate symptom relief.…”