The ideal therapeutic approach for subglottic stenosis (SGS) is surgicalreconstruction . However many elderly patient with underlying conditions are inoperable and require endobronchial palliation. We report our single center experience with endobronchial therapy for SGS.
We reviewed retrospectively data of of 115 patients (M-65, F-50) who were treated in our institution between the years 2001 to 2008. Causes of SGS included endotrachial intubation and mechanical ventilation (106) Wegener (2) Sarcoid (2), Amyliodosis (2) idiopathic (3). All patients presented with signs and symptoms of upper airway obstruction with typical flow volume curve. All patients underwent out patient fibroptic brnchoscopy using treating modelaties that includs YAG laser, balloon dilatation, stent insertion and brachytherapy.
760 endoscopic procedures (mean of 6.06 per patient) were performed. There were 460 sessions of laser treatment in 98 patients, 58 of them are well and asymptomatic with laser alone ,33 patients underwent stent insertion, among them 28 underwent brachytherapy for granulation tissue prevention ,of 30 patients of the 115 were presented with tarcheostomy cannula,15 of them underwent decannulation.(Fig 1) Complications includes granulation tissue formation , in rare cases stent migration (2) , tracheoesophegial fistula (1) and infections. Through out the follow up period 30 patients had died mainly due to the exacerbation of the underlying condition. Cumulative proportion survival at the end of 1 , 2,and 5 years were 80%,73%,62% respectively. (Fig 2).
Interventional endoscopy may have role in the treatment of subglottic stenosis in inoperable patients.Laser therapy may relieve the obstruction however granulation tissue frequently grow and repeated procedure may be required .In selected cases metal or silicone stents can be inserted to maintain airway patency and allow tracheostomy closure. Granulation tissue is a common problem in stents and require scheduled maintenance with laser. In some cases brachytherapy may prevent granulation.
In young patients with subglottic stenosis without comorbidities ,surgical reconstruction is the preferred option for treatment In elderly patients with underlying disease endoscopic therapy should be applied.
Nader Abdel Rahman, No Financial Disclosure Information; No Product/Research Disclosure Information