Bronchoscopic management as an alternative treatment in non‐operable benign tracheal stenosis

Abstract

Tracheal stenosis (TS) is abnormal tracheal lumen narrowing that can impair sufficient airflow and cause severe morbidity. Any level of the trachea can be affected from the cricoid cartilage to the main carina.TS may be congenital or idiopathic but most commonly is secondary to a variety of pathologies including tracheal trauma, malignancy, extrinsic compression or iatrogenic. Endotracheal intubation and tracheostomy are considered the most common causes of TS. 1 Historically, surgical management has been the mainstay of treatment in such cases, while endoscopic procedures are often viewed as a bridge to definitive surgical intervention either in simple stenosis or in high-risk patients. However, with the recent advances in the field of interventional pulmonology, definitive management of TS using multiple endoscopic methods became increasingly common especially in patients deemed non-operable. 2 We aimed to prospectively investigate the role of bronchoscopic management either by mechanical dilatation and

COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?

“…They reported a success rate of 96% in simple stenosis and 69% in complex stenosis. Our group has published analogous results following a similar clinical algorithm [ 15 , 16 ].…”

“…A rigid bronchoscopy was performed in the operating room under IV general anesthesia and muscle relaxation with manual jet ventilation. A mucosal web resection, dilatation, removal of granulation tissue, applying a combination of all available modalities (mechanical dilation, electrocautery, cryoablation), and/or a silicone stent placement were performed according to each patient’s specific indications and existing algorithms [ 14 , 15 , 16 ].…”

Nonmalignant Central Airway Obstruction: Options for Challenging Cases

“…Largely, the obstructive component can be treated surgically or endoscopically. A surgical approach is preferred for complex NMCAO; however, it may be limited by the patient's comorbidities and the length of the obstruction, 9 and may be prohibitive when the total vertical extension of the NMCAO is >4 cm. 4 Over the past decades, several treatments have been used to address the inflammatory and fibrotic component of NMCAO.…”

“…4 6 These classifications often dictate a management approach and are often utilized to determine the next best step in diagnostic and treatment algorithms. 9 Almost all these classifications share three elemental criteria for appropriate classification type: fixed (simple vs. complex) or dynamic, location, and obstruction severity ( Fig. 3 ).…”

“…This treatment modality should be reserved for nonsurgical candidates with complex stenosis and a primarily noninflammatory component. 9 Deploying an airway stent over a primarily inflammatory condition carries the risk of potentiating granulomatous inflammation and subsequent worsening of the NMCAO. 13 27 There are a wide range of airway stents available; however, uncovered self-expandable stents are generally contraindicated in NMCAO.…”