Interventional bronchoscopy for tuberculous tracheobronchial stenosis

Abstract

This study investigated the use of interventional bronchoscopic techniques in the management of patients with symptomatic tracheobronchial stenosis from tuberculosis.The current authors evaluated their experience with interventional bronchoscopic techniques in 21 consecutive patients at the Singapore General Hospital, Singapore, from November 1994 to March 2001. All patients underwent rigid bronchocopy using the Dumon rigid ventilating bronchosope under general anaesthesia. A combination of techniques was used (mechanical or balloon dilatation, Nd-YAG laser and stenting using the Dumon stent).The mean±sdincrease in luminal diameter of the tracheal lesions was from 4.5±2.5 mm pre-procedure to 11.9±1.7 mm post-procedure, whereas that for the mainstem bronchi stenosis was from 2.6±1.0 mm to 8.3±2.4 mm. All patients had immediate relief of symptoms post-intervention. Two patients who presented with acute respiratory failure could be weaned off mechanical ventilation immediately post-procedure. At the end of the study period, 52% (11 out of 21) remained asymptomatic.Bronchoscopic intervention provided immediate symptomatic relief in all of the studied patients. However, repeated sessions may be required to maintain this improvement. It is concluded that interventional bronchoscopic techniques are useful in the management of patients with tracheobronchial stenosis from tuberculosis.

A new tool for an old disease

“…The results reported by LOW et al [11] are considerable. Luminal diameters pre-and postprocedure were documented to increase on average by a factor of 2.6 in tracheal and 3.2 in bronchial lesions, comparing well with instant relief of dyspnoea reported previously for this method for other indications [12,13].…”

“…An afterthought may be allowed: the data presented by LOW et al [11] may stimulate interest for all those concerned with female issues; bronchial tuberculosis predominates in females, an observation repeatedly made by other investigators [9]. A satisfying explanation for this phenomenon has not yet emerged and should further motivate all investigators in this field to clarify the reasons for this observation.…”

“…A clear message from the paper by LOW et al [11] is the need for repetition of interventional procedures (one third of the group). Stent migration, restenosis and granulation tissue can complicate the ensuing course; well documented complications in the context of endobronchial management of stenoses [13].…”

“…Considering this standard of care, the report on endobronchial relief for tuberculous bronchial stenoses, by using interventional bronchoscopic techniques, by LOW et al [11] in this issue of the European Respiratory Journal is promising. In fact, "high-tech" experience applied to bronchial complications of a widespread disease has the potential for the development of new therapeutic options.…”

“…A moderate length follow-up (25 months) in the study by LOW et al [11] provides some useful information on the drawbacks encountered by this type of management. A total of 10 out of 21 patients continued to have symptoms ranging from cough to repeated chest infections and one patient proceeded to pneumonectomy for infectious problems.…”