Interventional bronchoscopy in the initial management of benign and malignant tracheal stenoses

Abstract

Introduction: Management of tracheal stenoses is inconsistent. Aim: To investigate the role of IB in the initial management of tracheal stenosis; evaluating treatment strategies used and complications encountered. Patients and methods: We prospectively recruited 30 patients presenting with bronchoscopically confirmed tracheal stenoses during 1 year.Twenty benign (6 simple and 14 complex) and 10 inoperable malignant tracheal stenoses were studied. All except 2 patients underwent rigid IB with different modalities applied. Each patient was followed-up for 6 months. Results:: All simple, 12 complex (not eligible for surgery) and all malignant stenoses were treated by 17 (mean of 2.83 per patient [p/p]), 52 (mean of 4.33 p/p) and 39 (mean of 2.83 p/p) IB procedures respectively including 1, 10 and 8 stents placement respectively with overall good therapeutic response after IB. Two patients with complex stenoses were sent for surgery. During the first 6 months after stent insertion, stent migration occurred in 27% and 12% and obstruction by mucus secretions occurred in 64 % and 37% of benign and malignant stenoses respectively. Granuloma formation occurred in 45% of benign stenoses. Tumor ingrowth occurred in 37% of malignant stenoses. All complications were non-life-threatening stent-related complications that were easily managed. During follow-up, 2 malignant patients died of disease progression. Conclusion:: IB is a useful option in the management of simple benign and inoperable complex benign and malignant tracheal stenoses patients associated with a relatively high rate of non-life-threatening stent-related complications that were easily managed.