Endobronchial tuberculosis in children: Defining the role of interventional bronchoscopy

Abstract

Introduction: Endobronchial tuberculosis (EBTB) can lead to bronchopulmonary complications when diagnosis is delayed. Bronchoscopic treatment in children can be challenging due to small airway size. We report our experience treating children with EBTB.Methods: Retrospective study (2014−2020) of patients diagnosed with EBTB.Flexible bronchoscopy (FB) was performed in patients with previous diagnosis of pulmonary tuberculosis (PTB), after respiratory/radiological worsening was observed in spite of medical treatment. Treatment consisted in oral corticotherapy in all patients, and interventional bronchoscopy in selected cases. Our aim is to describe the endoscopic findings, interventional bronchoscopy alternatives, and outcome.Results: Of 45 patients with PTB, 13 (28.9%, 7 M/6 F) were diagnosed with EBTB, with a mean age of 3.9 years (0.4−12.8). Four bronchoscopic patterns were observed. Endobronchial granuloma (N:9; 69.2%): Excision with rigid bronchoscopy was achieved in five (1−5 procedures per patient), while corticotherapy alone was preferred in the remaining four due to small size/distal location of the granuloma.Caseum obstruction (2; 15.4%): dense mucous molds were removed with flexible/ rigid bronchoscopy (6 and 8 procedures, respectively). Bronchial stenosis (1; 7.7%): two balloon dilatations with mitomycin-C application were performed. Extrinsic compression (1; 7.7%): oral corticotherapy alone was initiated. One patient developed bronchoscopy-related complications (pneumothorax requiring thoracic tube 48 h).With a medium follow-up of 4.6 years (1.8−7.6), three patients developed bronchiectasis while the remaining 10 improved clinically and radiologically. Conclusion:Bronchoscopic findings in EBTB include granuloma, stenosis, caseum obstruction and external compression. In selected cases, interventional bronchoscopy can minimize long-term bronchopulmonary complications.

Advanced bronchoscopic interventions in pediatric endobronchial tuberculosis—A single center experience

“…This procedure can be combined with cryoablation, electrocautery cuts followed by intralesional corticosteroid, or topical mitomycin-c application. 4 In our series, all four children with fibrostenosis underwent balloon dilatation, three in our institute and one elsewhere. Airway patency with just balloon dilatation was established only in a single child (25%).…”

“…Data on interventions for pediatric EBTB are limited to case reports and small series. 3,4 Balloon dilatation is often the first intervention in patients with stenotic EBTB. In our Institute, we use a CRE balloon of appropriate size, inserted through the stenotic segment using a rigid bronchoscope.…”

“…6 Interventional procedures are only required if there is significant airway stenosis of >50%. 4 Surgical resection was once considered a standard of care in these cases. 7 Developments in interventional bronchoscopy have allowed for the nonsurgical management of EBTB when conventional therapy fails.…”

Multimodality Endoscopic Approach for Benign Central Airway Stenosis in Pediatric Tuberculosis: A Case Report

“…It is also proven to be highly effective in the treatment of scarring central airway stenosis caused by bronchial tuberculosis. 5 , 9 The choice of thermal therapy for children is usually argon plasma coagulation (APC) which relies on argon gas to conduct an electrical current to perform non-contact coagulation to achieve a superficial necrosis effect on the target tissues. In the comparison of inflammatory and scar tissue formation responses to the use of cryoablation, APC, and radiofrequency, cryotherapy is reported to result in a significantly lower response of inflammation and scar tissue formation at the targeted sites in a mice experiment.…”

“…Research reported the institution of interventional treatments such as balloon dilatation, thermal ablation, cryoablation, clamping, and stent placement, after half a month to one month of antituberculosis treatment, can reduce airway stenosis and pulmonary function damage in children. [7][8][9] Here we report a pediatric tuberculosis case complicated with benign stenosis of the central airway successfully managed with bronchoscopy balloon dilation with cryotherapy at an early anti-TB treatment phase.…”