Management of benign tracheal stenosis: the endoscopic approach

Abstract

<b>Introduction:</b> Surgical resection is the gold standard treatment for benign tracheal stenosis (BTS). However, endoscopic procedures are also ideal for inoperable patients or in case of acute respiratory failure. <b>Aim:</b> The aim of this study was to describe our experience with interventional bronchoscopy (IB) in the treatment of BTS. <b>Methods:</b> A prospective study (2017-2021) including patients presenting with BTS treated with IB techniques in the Pulmonology department II of Abdurrahman Mami Hospital in Tunisia. <b>Results:</b> We included 54 patients with a 1,1 sex-ratio and a mean age of 36,6 years. Dyspnoea was reported in all patients. Position of the BTS was sub-glottic in 44% of cases, in the upper tracheal third (22%), middle third (26%) and lower third (8%). Mean degree of obstruction was 79%. The BTS had a web-like aspect in 11 patients and a complex stenosis aspect in 43 patients (78%). Etiologies included post-intubation stenosis (n=50), benign tracheal tumor, granulomatosis with polyangiitis, caustic ingestion and idiopathic BTS (in one case each). The 54 patients were treated by mechanical dilation alone in 25 cases, associated with electrocautery in 6 cases and stent placement in 23 cases. Success rate was 96%: two cases of failure were reported and the 2 patients underwent urgent tracheotomy. During follow-up, stent migration was noted in 13 patients mainly in the subglottic area. Seventeen patients were sent for surgery after reoccurrence of the stenosis. <b>Conclusion:</b> Interventional bronchoscopy is a useful tool in the treatment of simple benign and inoperable complex benign tracheal stenosis.