Abstract
BackgroundManagement of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment.MethodsPatients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation.ResultsA total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions.ConclusionsBTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising.
Highlights
The most common etiology for acquired benign tracheal stenosis (BTS) is tracheal intubation or tracheostomy [1,2]
Brachytherapy was used when a patient required 3 or more interventions within 6 months due to recurrent granulation tissue formation In cases of recurrent refractory granulation tissue around a metal stent placed for restoration of airway patency, High-dose rate (HDR) endobronchial brachytherapy and single application of a total 10 Gy was administrated along the stent using a brachytherapy remote afterloader with a 192Ir source as previously described [16]
All patients presented with signs and symptoms of upper airway obstruction including shortness of breath, stridor, cough, dyspnea and wheezing, and presented with typical flow volume curve that demonstrate fixed airway obstruction The etiologies for BTS are presented on Table 1
Summary
The most common etiology for acquired benign tracheal stenosis (BTS) is tracheal intubation (even for a short period of time) or tracheostomy [1,2]. The management of BTS varies with the type and extent of the disease and depends upon the age and co-. The aim of the current report was to review our experience in treating BTS secondary to various etiologies, review the treatment strategies used, and evaluate long-term success rates and complications. Management of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient’s age and general health status, we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment
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