Systematic Review of Endoscopic Balloon Dilation of Pediatric Subglottic Stenosis

Abstract

Objectives: 1) Critically assess the literature reporting on the outcomes of endoscopic balloon dilation (EBD) of pediatric subglottic stenosis. Methods: Adhering to PRISMA principles, a systematic review of pediatric EBD was performed using the PUBMED (MESH) and EMBASE databases. Inclusion criteria consisted of sample size of five or greater pediatric patients, and primarily EBD without adjuvant procedures such as laser ablation or prolonged stenting. Meta-analysis was performed with random effects modeling and meta-regression. Results: Eleven studies were identified on the initial search. Cross-checking references led to identification of 2 additional studies. After detailed review and application of the inclusion/exclusion criteria, 6 studies were included in the final dataset with 145 total subjects. All studies were case series (level 4 evidence). The average sample size was 16 (range = 8-37). Grand mean age was 29.3 months (range = 4.8-60 months). EBD treatment success was defined as avoidance of more definitive procedures (airway reconstruction, tracheostomy). The random effects model estimate of the overall treatment success was 64.8% (95% CI = 56.5-73.1%, P < 0.001, Q test for heterogeneity = 31.0, P < 0.001, I squared = 74.2%). Follow-up was inconsistently reported but averaged 5.0 months (range = .25-12.5 months) in studies that did report it. Only one study reported significant complications (one death, two tracheal lacerations). Meta-regression results did not indicate that age, Cotton-Myer stage (1, 2, or 3) or primary versus secondary treatment significantly affected the odds of EBD treatment success. Conclusions: EBD is successful in the majority of patients over short-term follow-up, and reported complication rates are low. Factors predictive of treatment success have not been conclusively determined.