Bronchoscopic balloon dilatation may be performed via the rigid or flexible bronchoscope. The balloon can be precisely placed across the stenosis and gradually inflated to impart radially directed forces. It is performed under local anesthesia and sedation when performed via flexible bronchoscopy. It can be closely monitored using fluoroscopy guidance or under direct bronchoscopic vision, may be repeated, and is a safe procedure.3–4
The choice of balloon size is based on the bronchoscopic assessment of the stenosis and as demonstrated on radiographic studies such as CT. The balloon is inserted in the airway directly through the working channel of the bronchoscope or over a guidewire. The inflation syringe is used to inflate and deflate the balloon and to monitor the balloon pressure. Balloon inflation may be carried out either using normal saline solution or a radiopaque solution (eg, urograffin 10 mL plus normal saline solution 10 mL) when fluoroscopy is used to monitor the dilatation.,2
When fluoroscopy is used, the “waist” caused by the stricture serves as a guide to the accurate placement of the balloon catheter, and its opening up serves as a marker of the degree of dilatation achieved. Inflation of the balloon is usually maintained for 30 to 120 s, keeping a close watch on the pulse oximeter and vital parameters.2,4
If necessary, the procedure is repeated either with the same balloon or one with a larger diameter.