Pulmonary Procedures |

Management of Benign Tracheal Stenosis: Gentle vs Rigid Dilation FREE TO VIEW

Abdul Hamid Alraiyes; Danai Khemasuwan, MBA; Yvonne M. Meli, CCRN; Joseph Cicenia; Thomas Gildea, MS; Wissam Jaber; Michael Machuzak; Atul Mehta; Sonali Sethi; Juan Wang; Francisco Almeida, MS
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Cleveland Clinic Foundation, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):733A. doi:10.1378/chest.1994306
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SESSION TITLE: EBUS and Advanced Bronchoscopy Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Benign tracheal stenosis (BTS) secondary to traumatic injury, inflammatory disorders or idiopathic causes can prompt disturbing respiratory symptoms. These symptoms mandate intervention, typically starting with airway dilation. Multiple tools including rigid bronchoscopy, boogies and balloons are used for the purpose.

METHODS: Data on prospectively enrolled patients undergoing dilatation for BTS between December 2010 and March 2014 were extracted from our therapeutic bronchoscopy database and analyzed. Patients were divided into two groups: Rigid Bronchoscopy Dilatation (RBD) and Controlled Radial Expansion Balloon Dilatation (CBD). We defined use of CRE balloon as “Gentle Dilatation”. Time interval between the baseline treatment and clinical recurrence with need for repeat intervention was recorded.

RESULTS: A total of 47 patients underwent dilations for BTS during the study period: 21 RBD and 26 CBD. One or more additional procedure, such as electrocautery blade incision, prior to dilation or Mitomycin application or instillation of steroids following the procedure was performed at the discretion of the bronchoscopist. Tracheal stenosis recurrence occurred in all cases (100%) regardless of the technique used. However, the time interval between the baseline dilation and recurrence of the stenosis was shorter following RBD with a mean of 30.8 days (SD 17.6 95% CI, 22.7 - 38.8) compared with 114.5 days for CBD (SD 54.3 95% CI, 92.5 - 136.4), p=0.0001. There were no complications in either group.

CONCLUSIONS: Gentle dilation of the BTS using CRE balloon affords more durable results than RBD. We hypothesize that trauma associated with the RBD is of grater severity and is responsible for the early restenosis compared to CBD.

CLINICAL IMPLICATIONS: Sequential rigid dilation of benign tracheal stenosis should be replaced with gentle dilatation using the CRE balloon. RBD may still be required in select patients in whom maintenance of ventilation during the procedure is mandatory and when CBD is not available or not successful. Larger controlled trials required.

DISCLOSURE: The following authors have nothing to disclose: Abdul Hamid Alraiyes, Danai Khemasuwan, Yvonne M. Meli, Joseph Cicenia, Thomas Gildea, Wissam Jaber, Michael Machuzak, Atul Mehta, Sonali Sethi, Juan Wang, Francisco Almeida

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