The role of bronchoscopy in the multidisciplinary approach to benign tracheal stenosis

Abstract

Benign tracheal stenosis can cause dyspnea, wheezing, and cough mimicking other obstructive lung diseases which often leads to a delay in the diagnosis. Risk factors and etiologies for tracheal strictures include autoimmune diseases, infection, gastro-esophageal reflux disease (GERD), radiation injury and iatrogenic factors such as post-intubation and post-tracheostomy. Once suspected, tracheal strictures are diagnosed by performing a thorough evaluation involving clinical exam, laboratory workup, pulmonary function test, chest imaging and bronchoscopy. Bronchoscopy plays a pivotal role in the diagnosis of stenosis and along with the imaging and physiologic assessments leads to a proper description of the stenosis based on all parameters that matters for management. Surgical resection provides a definitive management in most patients with idiopathic or post intubation/tracheostomy stenosis, however, factors such as severe co-morbidities, length and location of the stricture can preclude patients from undergoing curative surgery. Several bronchoscopic interventions including mechanical or laser assisted dilation, electrosurgery (ES), airway stenting and pharmacological treatment with mitomycin C (MMC) and intralesional steroid have been reported in the literature for management of patients who are not surgical candidates. Herein, we review the role of bronchoscopy and illustrate the importance of a multi-disciplinary team (MDT) approach comprising of interventional pulmonologists, thoracic surgeons and otorhinolaryngologists in the diagnosis and management of patients with benign tracheal stenosis.

Non-intubated bronchoscopic tracheobronchial surgeries with electroencephalogram-monitored intravenous anesthesia: feasibility and outcomes

“…Moreover, our results indicate that tracheal operations result in longer desaturation than do bronchial surgeries regardless of their high success rate, which might imply that lesions at trachea are riskier due to complete airway obstruction and smaller respiratory reservoir. NIBTS may facilitate the bronchoscopic management for tracheal pathology ( 28 ) and enhance the recovery without residual muscle relaxation.…”

Endoscopic treatment of benign tracheal stenosis: a single-centre study

“…All patients received the same therapy with endoscopic dilation and intramucosal corticosteroid injection with granulomatosis with polyangiitis showing the highest success rate of 75%, compared to 71% and 56% with traumatic and idiopathic aetiology, respectively [32]. In the end, several studies emphasised that, regardless of the cause, additional adjuvant corticosteroid injection is superior compared to endoscopic dilation alone [5,24,32]. In 2016, we introduced triamcinolone to be administered locally into the lesion at the end of the procedure.…”

“…Most commonly, benign tracheal stenosis is observed in young to middle-aged women, which may lead to misdiagnosis of bronchial asthma and therefore delayed diagnosis of benign tracheal stenosis [1][2][3]. There are a few potential causes, including damage from a prior intubation [1], damage from inhaling chemicals or heat, an autoimmune disease, gastro-oesophageal reflux disease (GERD) or an unknown cause, in which case it is known as idiopathic subglottic stenosis [4,5]. The most common causes of benign tracheal stenosis are post-intubation tracheal stenosis (PITS) and post-tracheostomy tracheal stenosis (PTTS), accounting for 19% and 65% of cases, respectively [6,7].…”

A prediction model for risk of low oxygen saturation in patients with post-tuberculosis tracheobronchial stenosis during bronchoscopy

“…Airway stenting has been demonstrated to be an effective and safe treatment option for PTTS patients. 13 A rigid bronchoscope providing a larger working channel is usually used for airway stenting and requires general anesthesia. 39 It was concluded with the previous studies that administration of muscle relaxants to PTTS patients may exacerbate airway obstruction, leading to LOS occurrence.…”

“…8,9 In contrast, minimally invasive bronchoscopic interventions, such as thermal ablation therapy, cryotherapy, balloon dilation and airway stenting, have opened up a new way to deal with PTTS and gained popularity, benefiting a considerable number of selected patients who failed to perform surgical correction due to poor pulmonary reserves, inferior health conditions, technical difficulties and significant medical comorbidities. [10][11][12][13][14] For patients with PTTS, restenosis is a frequent occurrence, despite efficacious bronchoscopic management. Therefore, they will undergo bronchoscopic procedures as many times as needed.…”