Long-term Results of Fiberoptic Bronchoscopic Balloon Dilation in the Management of Benign Tracheobronchial Stenosis

doi:10.1378/chest.114.3.796

Chest

Volume 114, Issue 3, September 1998, Pages 796-800

https://doi.org/10.1378/chest.114.3.796 Get rights and content

Study Objectives: To assess the short- and long-term effects of balloon dilatation using a fiberoptic bronchoscope in the management of benign tracheobronchial stenosis (TBS). Treatment strategies have included open surgical resection or endoscopic techniques. The endoscopic techniques have included Nd:Yag laser, cryotherapy, stent placement, rigid bronchoscopy, and balloon dilation (BD).

Design: Prospective sequentiality study.

Setting: Tertiary care academic hospital.

Patients: This study consisted of 14 patients, ages ranging from 35 to 72 years, whose symptoms of dyspnea, cough, or wheeze were attributable to a TBS.

Intervention: This study describes the use of flexible fiberoptic bronchoscopy (FFB) with a balloon catheter for airway dilation. Each patient underwent FFB, in which a balloon catheter was threaded over the guidewire and positioned across the stenosis. Under direct visualization, the balloon was inflated for 30 to 120 s. Repeat inflation-deflation cycles were done if airway narrowing remained after the initial attempt.

Results: Seven patients had TBS following lung transplantation, three after sleeve resection, two following irradiation therapy, and two due to fibrosing mediastinitis. All patients had initial success: increased airway dimensions and symptom relief. Ten patients had successful airway dilation after one session. Of the four patients who required multiple sessions, one had cryotherapy and in each of the others an airway stent was placed.

Conclusions: BD offers immediate symptom relief and can be used in conjunction with Nd:Yag laser, cryotherapy, stent placement, or mechanical dilation with a rigid bronchoscope. The advantages of FFB with BD include operator familiarity, patient safety, and avoidance of general anesthesia.

(CHEST 1998; 114:796–800)

Abbreviations: BC=balloon catheter; BD=balloon dilation; FFB=flexible fiberoptic bronchoscopy; TBS=tracheobronchial stenosis

Section snippets

MATERIALS AND METHODS

All endoscopic procedures were carried out with an FFB with a working channel of 2.0 or 2.2 mm (BF P20; Olympus America; Melville, NY), using a guidewire and a BC, under fluoroscopy. A variety of inflatable balloons were used with diameters of 10 to 15 mm and lengths from 2.5 to 4.0 cm, using a range of pressures of 45 to 131 psi (Olbert Catheter System; Meadox Surgimed; Oakland, NJ; and Rigiflex OTW; Boston Scientific Corp; Watertown, MA). Table 1 lists the various BCs and their

Immediate

The immediate results were judged by clinical response and endoscopic appearance. All patients had initial success characterized by increased luminal dimensions and symptom relief. There were no technical failures. No patients complained of pain or discomfort during the procedure.

Long Term

Ten of 14 patients were successfully treated with only one BD session (Table 2). These patients have not required any intervention during their lifetime or with up to 72 months follow-up. For the remaining four

DISCUSSION

The technique of BD has been described previously for TBS. The technique has been used in concert with Nd:Yag laser² or with self-expanding metal stents.⁴ It has also been used in infants with congenital and acquired stenosis.¹¹,¹² In most cases, BD was used with either rigid bronchoscopy or without bronchoscopy but with fluoroscopy. In this study, we describe the long-term follow-up of patients after BD using FFB with local anesthesia and conscious sedation.

The various etiologies and

REFERENCES (23)

CarlinBW et al.
The treatment of endobronchial stenosis using balloon catheter dilation.
Chest
(1988)
KellerC et al.
Fiberoptic bronchoplasty: description of a simple adjunct technique for the management of bronchial stenosis following lung transplantation.
Chest
(1992)
CarreP et al.
Balloon dilatation and self-expanding metal Wallstent insertion: for management of bronchostenosis following lung transplantation.
Chest
(1994)
OlssonT et al.
Bronchostenosis due to sarcoidosis—a cause of atelectasis and airway obstruction simulating pulmonary neoplasm and chronic obstructive pulmonary disease.
Chest
(1979)
FoutyBW et al.
Dilatation of bronchial stenoses due to sarcoidosis using a flexible fiberoptic bronchoscope.
Chest
(1994)
GroffDB et al.
Gruentzig balloon catheter dilation for acquired bronchial stenosis in an infant.
Ann Thorac Surg
(1985)
MathurPN et al.
Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction.
Chest
(1996)
PersonneC et al.
Indications and technique for endoscopic laser resection in bronchology: a critical analysis based upon 2,284 resections.
J Thorac Cardiovasc Surg
(1986)
HebraA et al.
Balloon tracheoplasty in children: results of a 15 year experience.
J Pediatr Surg
(1991)
FowlerCL et al.
Dilatation of bronchial stenosis with Gruentzig balloon.
J Thorac Cardiovasc Surg
(1987)

FerrettiG et al.

Benign noninflammatory bronchial stenosis: treatment with balloon dilation.

Radiology

(1995)

Cited by (95)

Lung involvement in ANCA-associated vasculitis
2020, Presse Medicale
Lung involvement is one of the most common clinical features in ANCA-associated vasculitides (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). In this review, we detail the five main presentations of pulmonary involvement in AAV: necrotizing granulomatous inflammation, tracheobronchial inflammation, pulmonary capillaritis, interstitial lung disease (ILD) and asthma with their clinical, radiological and therapeutic characteristics. The prevalence of these manifestations is variable according to the subtype of AAV, necrotizing granulomatous inflammation and tracheobronchial inflammation being defining features of GPA whereas ILD is primarily seen in patients with MPA, especially in association with ANCA directed against myeloperoxydase (MPO-ANCA), and asthma is characteristic of EGPA. Despite recent progresses in the diagnosis and management of these conditions, several questions remain and are discussed here, including local treatments for subglottic stenosis, the uncertain efficacy of plasma exchanges for alveolar hemorrhage, the potential role of antifibrotic agents in ILD associated with MPA, and the use of novel anti-IL-5 strategies in EGPA.
Aggressive and progressive fibrosing mediastinitis involving the thoracic spine mimicking malignancy: A case report
2019, Radiology Case Reports
Fibrosing mediastinitis is an uncommon benign disorder in which a chronic inflammatory reaction results in diffuse fibrosis of the mediastinum, potentially compromising the airways, great vessels and other mediastinal structures. Herein we describe a progressive course of fibrosing mediastinitis in a 72-year-old man. Computed tomography images depicted a diffuse, infiltrative, soft tissue mass involving the esophagus and superior vena cava in the mediastinum. Magnetic resonance imaging revealed destruction of the adjacent thoracic spine. Positron emission tomography-computed tomography also revealed increased metabolism in the periphery of the mass.
Treatment of Tracheobronchial Injuries: A Contemporary Review
2019, Chest
Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.
Idiopathic fibrosing mediastinitis: Spectrum of imaging findings with emphasis on its association with IgG4-related disease
2015, Clinical Imaging
Citation Excerpt :
Hemoptysis and pulmonary hemorrhage can be treated with transcatheter embolization and/or endobronchial laser coagulation. SVC syndrome or stenosis of the pulmonary artery can both be treated with percutaneous balloon angioplasty and stenting, although retreatment is often needed and some patients may still go on to surgical repair [31,32]. Idiopathic FM is an infiltrative disorder characterized by a progressive encasement of the mediastinal structures that has received less attention in the radiological literature than the granulomatous histoplasma-associated form of FM.
The purpose of this study was to review the clinicoradiological features of idiopathic fibrosing mediastinitis (FM).
The records of six patients with idiopathic FM were retrospectively reviewed.
The most common presenting symptom was cough. There were three localized forms and three diffuse forms. Definitive histological diagnosis was most commonly made with mediastinoscopy. Interestingly, three of our patients had disease manifestations of IgG4-related disease (IgG4-RD) outside the mediastinum.
The imaging findings of idiopathic FM vary depending on the involved mediastinal structures. Therapeutic options include medical treatment, stenting, or surgery. Radiologists should pay attention to the possible association of idiopathic FM with extrathoracic manifestations of the IgG4-RD spectrum.
Complications Following Carinal Resections and Sleeve Resections
2015, Thoracic Surgery Clinics
Citation Excerpt :
Bronchoscopic resection of granulomas at the suture line is usually curative. Patients with benign anastomotic strictures are best managed initially with bronchoscopic balloon dilation.55 If the stricture recurs, repeated bronchoscopic dilations can be performed.
Endobronchial tuberculosis
2015, Indian Journal of Tuberculosis
Endobronchial tuberculosis refers to tuberculous infection of the tracheobronchial tree. Diagnosis requires a high index of suspicion since symptoms are attributed to co-existing pulmonary tuberculosis and airway lesions are not detectable on chest radiograph. While computed tomography and bronchoscopy are useful for the evaluation of tracheobronchial stenosis or obstruction, goals of treatment remain in the eradication of tubercle bacilli and prevention of airway stenosis. Corticosteroids may halt progression of active disease to fibro-stenotic stage, however if tracheobronchial stenosis causing post-obstructive pneumonia, atelectasis and dyspnea has occurred, airway patency must be restored mechanically by surgery or bronchoscopic techniques.

View all citing articles on Scopus

: Manuscript received October 21, 1997; revision accepted March 16, 1998.

View full text

Chest

Long-term Results of Fiberoptic Bronchoscopic Balloon Dilation in the Management of Benign Tracheobronchial Stenosis

Section snippets

MATERIALS AND METHODS

Immediate

Long Term

DISCUSSION

Chest

Chest

Chest

Chest

Chest

Ann Thorac Surg

Chest

J Thorac Cardiovasc Surg

J Pediatr Surg

Dilatation of bronchial stenosis with Gruentzig balloon.

J Thorac Cardiovasc Surg

Benign noninflammatory bronchial stenosis: treatment with balloon dilation.

Radiology