Benign tracheal stenosis (BTS) can be a life threatening condition for which surgical resection / reconstruction is often considered. Many patients presenting with BTS are poor surgical candidates and interventional bronchoscopy (IB) may be an attractive alternative to surgery in such patients.
26 patients not considered candidates for surgical resection due to physiologic impairment underwent IB for BTS between 1995 and 2002. Rigid bronchoscopic airway control was routinely utilized. Data regarding patient demographics and duration of symptom palliation were reviewed.
There were 12 males and 14 females, with a median age of 56 years. Expandable wire stents were used as primary treatment in 18 patients. Tracheal pneumatic balloon dilation was primary treatment for 5 , and laser fulguration in 3. A total of 58 procedures were performed. The mean number of procedures per patient was 2.3 with a range of 1 to 9. These included 26 stent insertions, 23 balloon dilations and 9 laser/manual debridements. Indication for intervention was dyspnea and/or stridor in 20 (77%) patients, respiratory failure due to stenosis in 2 (7%), hemoptysis with stenosis in 1 (7 %) and intractable cough with stenosis in 3 (11.5%). Four (15.3%) patients had complications (pneumothorax/2, hemoptysis/1, and airway obstruction requiring tracheostomy/1. There were no airway perforations. The 30-day mortality was 11.5% (3/26). Palliation of airway symptoms was established and maintained in 23/26 (88.4%) patients at a median follow up of 36 months (range 5 –53).
IB approaches appear to be a safe and effective management of BTS.
Patients with significant BTS who are not candidates for surgical resection may receive significant palliation of their symptoms with these IB approaches.
Endoscopic findingsNStenosis9Malacia7Granulation tissue2Pos lung TX2Wegener’s disease2Squamous metaplasia1Papillomatosis1Idiopathic2
R.S. Santos, None.