Management of tracheal stenosis has been evolving and currently no consensus exists regarding the correct techniques for initial management which include bronchoscopic therapies as well as surgical repair.
All patients with the diagnosis of tracheal stenosis referred to Interventional Pulmonology at the University of Florida from July 2002 to April 2009 were included. Using conscious sedation, all patients underwent flexible bronchoscopy and balloon dilatation with the CRE balloon catheter (sizes 10-11-12 mm or 12-13.5-15 mm) and adjunct procedures as necessary. The demographics, etiology, location, degree of stenosis pre and post intervention, and the numbers of interventions for each patient were recorded.
A total of 41 patients were included (males 11, females 30). Locations included subglottic n = 14, proximal trachea n = 23, mid trachea n = 3, and distal trachea n = 1. Etiologies predominantly included post tracheostomy stenosis (n = 21) and post intubation stenosis (n = 6). Of the remaining 13 patients, 4 had tracheal involvement due to systemic disease, 2 each were post radiation and post surgical, 1 had stenosis due to treatment of respiratory papillomatosis, 1 had a vascular ring causing stenosis, 1 had inhalational injury, and two patients had idiopathic stenosis. The degree of stenosis at the time of initial evaluation varied between 30% and 90%. Adjunct procedures included topical mitomycin-C application (n = 31), electrocautery using a Gold probe catheter or APC (n = 14), Cryospray (n = 1), and a combination of electrocautery and Cryospray (n = 2). Intralesional Depomedrol injection was performed in 1 patient. Complications included periprocedural intubation due to airway edema in 4 patients.
Balloon dilatation with a CRE balloon catheter performed via flexible bronchoscopy was an effective and relatively safe procedure. Patients tolerated the procedure well with conscious sedation.
Flexible bronchoscopy with balloon dilation is a relatively safe procedure in the management of benign tracheal stenosis. Our results are encouraging and combined with other adjunct therapies may be offered to symptomatic patients as initial treatment.
Varsha Kulkarni, No Financial Disclosure Information; No Product/Research Disclosure Information