Benign tracheal strictures have historically been treated by repeated dilatations using rigid bronchoscopy and general anesthesia. An alternative approach utilizing conscious sedation, fluoroscopy, flexible bronchoscopy and Savary-Gilliard esophageal dilators is reported.
A retrospective review of our patients undergoing awake tracheobronchial dilatation was performed, after approval for IRB exemption was obtained. The procedure, performed with the patient receiving intravenous conscious sedation, is accomplished with flexible bronchoscopy through the oropharynx, passage of a guidewire into the airway, and sequential Savary-Gilliard bougie dilatation using fluoroscopic confirmation of guidewire and dilator position.
Since 2002, of 14 consecutive patients requiring bronchoscopy and tracheobronchial dilatation without other associated procedures, 8 patients have undergone awake dilatation (AD) without rigid bronchoscopy (RB). Primary diagnoses included Wegener’s granulomatosis, idiopathic tracheal stenosis, and anastomotic stricture or tracheomalacia. The maximal dilator size achieved was significantly greater for patients undergoing AD rather than RB (median size, 33F v. 30F, p<0.001, Student’s t-test). All patients undergoing AD had lesions that were due to inflammatory disease or that were not amenable to tracheal resection. No pneumothorax, tracheal laceration, procedural death or complications occurred. Patients were typically discharged several hours after the procedure. Improvement in symptoms of airway obstruction was achieved in 7 patients. With a median follow-up of 9 months (range, 2 weeks to 34 months), 3 patients have required repeat dilatation.
Tracheobronchial stenoses can be dilated effectively and safely using the Savary-Gilliard guidewire dilatation system under fluoroscopic guidance.
Awake flexible bronchoscopy and Savary-Gilliard wire-guided tracheobronchial dilatation appears to be less traumatic than rigid bronchoscopy and can be accomplished on an outpatient basis without the use of either rigid bronchoscopy or general anesthesia.
Andrew Chang, None.