Interventional therapy via flexible bronchoscopy in the management of foreign body‐related occlusive endobronchial granulation tissue formation in children

Abstract

Background Occlusive granulation tissue formation, as one of the most common sequelae of chronic foreign body aspiration, can cause tracheobronchial obstruction and delayed fixed airway stenosis necessitating interventions. The aim of this study was to explore the clinical efficacy and safety of interventional therapy via flexible bronchoscopy for treatment of granulation tissue related airway obstruction secondary to foreign body aspiration in children. Method Patients with long‐term foreign body related granulation tissue were treated with flexible bronchoscopy therapeutic modalities, including forceps, cryotherapy, holmium laser, and balloon dilatation. Clinical efficacy was evaluated by clinical symptoms and endoscopic manifestations. Results A total of eight patients with granulation tissue hyperplasia caused by foreign body in bronchus, with a median age of 29.5 (range, 18–54) months, underwent interventional therapy between January 2016 and December 2019. Four patients received forceps and CO2 cryotherapy and one patient required forceps only. The remaining three patients received holmium laser combined with CO2 cryotherapy, and one of them required additional balloon dilatation. Four cases required a second cryotherapy procedure, and one case received three cryotherapy procedures for extensive granulation tissue. The treatment efficacy was 100% without complications. Conclusion Interventional procedure via flexible bronchoscopy is a safe, reliable, and effective method in the management of tracheobronchial obstruction and stenosis caused by foreign body‐related granulation tissue hyperplasia. It is worthy of clinical application.

Successful removal of distal persistent foreign body airway with CO2 cryotherapy in a child

“…Generally, small granuloma resolve spontaneously after the FB is removed or after a course of oral corticosteroids. However, long-standing FB can provoke intense inflammatory reactions and extensive granulation [ 8 ]. In our case, the delayed diagnosis of FBA led to the formation of significant granulation tissue whose size and shape made it difficult to grasp the FB with flexible forceps.…”

“…Shuxian Li et al. reported different therapeutic modalities in granulation tissue removal from children's deep bronchi by interventional procedures via flexible bronchoscopy (four patients received forceps and CO2 cryotherapy, one received forceps only and three received holmium laser combined with CO2 cryotherapy) [ 8 ].…”

“…Despite the promising results reported in adults [ [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ], the use of a cryoprobe during flexible bronchoscopy in children with FBA or granulation tissues caused by FB is largely limited to case reports and small case series [ 8 , 22 , 23 ]. Cryoprobes come in both flexible and rigid forms [ 14 ].…”

Pseudobronchial crista-like change in children: A case report

“…Therefore, it is very important to accurately recognize and distinguish Pseudobronchial Crista-like Change. In case of bronchial foreign bodies complicated with Pseudobronchial Crista-like Change, the foreign bodies should be promptly removed, the cristae should be cut-off, and the narrow bronchus should be dilated under the bronchoscope [ 6 ]. In this case, the distal cristae of the left main bronchus detected by the initial bronchoscopy were misdiagnosed as bronchial opening stenosis caused by bronchial dysplasia.…”

Adult with mass burnt lime aspiration: A case report and literature review

“…Some rare benign airway diseases, such as tracheobronchopathia osteochondroplastica[ 24 ], complicated by severe airway stenosis and recurrent obstructive infection, endoscopic excision and laser ablation are often used to release the airway obstruction. Because of the chemical reaction properties of burnt lime, electroexcision and laser dissection are not suitable[ 25 , 26 ]. Because the texture of the lime particles in the bronchi was soft, it was hard to clamp the particles.…”