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Original article

Vol. 154 No. 6 (2024)

Endoscopic treatment of benign tracheal stenosis: a single-centre study

DOI
https://doi.org/10.57187/s.3363
Cite this as:
Swiss Med Wkly. 2024;154:3363
Published
17.06.2024

Summary

BACKGROUND: Benign tracheal stenosis is relatively rare but remains a significant chronic disease due to its drastic symptoms including dyspnoea and inspiratory stridor, and consequent negative effect on quality of life. Traditionally, the surgical approach by resection of the stenotic tracheal segment has been the therapy of choice. However, endoscopic techniques have arisen and may offer a safe and less invasive alternative.

OBJECTIVES: The aim of the retrospective study was to evaluate procedure-related safety and outcome of endoscopic treatment of benign tracheal stenosis at a single centre.

METHODS: The study included all patients at our institution who between 2013 and 2022 had received endoscopic treatment of benign tracheal stenosis by rigid tracheoscopy, radial incision by electric papillotomy needle and dilation (endoscopic tracheoplasty) followed by triamcinolone acetonide as a local submucosal injection and additionally, from 2020, budesonide inhalation.

RESULTS:A total of 22 patients were treated in a total of 38 interventions, each resulting in immediate improvement of symptoms. There were no peri-interventional complications or mortality. Of the 38 interventions, 11 received no triamcinolone acetonide administration, resulting in a 54.5% recurrence rate after an average of 21.1 (±18.0) months, while 27 had local triamcinolone acetonide, with a 37% recurrence rate. Since 2020, we additionally initiated post-interventional budesonide inhalation as recurrence prophylaxis for newly admitted patients and patients with recurrences(n = 8), of whom only one (12.5%) has to date experienced a recurrence.

CONCLUSION: Our results indicate that endoscopic tracheoplasty offers a safe and successful, minimally invasive alternative to open surgery for patients with benign tracheal stenosis. We recommend local administration of triamcinolone into the mucosa as an additional treatment to decrease the risk of recurrence. However, given the uncontrolled study design and low sample size, safety and effectiveness cannot be conclusively demonstrated. Nonetheless, our findings suggest promising avenues for further investigation. Further studies on the additional benefit of inhaled corticosteroids are warranted.

References

  1. Lorenz RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg. 2003 Dec;11(6):467–72. 10.1097/00020840-200312000-00011 DOI: https://doi.org/10.1097/00020840-200312000-00011
  2. Zubairi AB, Dildar B, Husain SJ, Khan MF. Tracheal stenosis mimicking severe acute asthma. BMJ Case Rep. 2010 Oct 12:2010:bcr1220092517. Epub 2010/01/01. doi: 10.1136/bcr.12.2009.2517. PubMed PMID: 22789696; PubMed Central PMCID: PMCPMC3029208. DOI: https://doi.org/10.1136/bcr.12.2009.2517
  3. Nagappan R, Parkin G, Wright CA, Walker CS, Vallance N, Buchanan D, et al. Adult long-segment tracheal stenosis attributable to complete tracheal rings masquerading as asthma. Crit Care Med. 2002 Jan;30(1):238–40. 10.1097/00003246-200201000-00034 DOI: https://doi.org/10.1097/00003246-200201000-00034
  4. Marchioni A, Andrisani D, Tonelli R, Andreani A, Cappiello GF, Ori M, et al. Stenting versus balloon dilatation in patients with tracheal benign stenosis: The STROBE trial. Laryngoscope Investig Otolaryngol. 2022;7(2):395-403. Epub 2022/04/19. doi: 10.1002/lio2.734. PubMed PMID: 35434321; PubMed Central PMCID: PMCPMC9008152. DOI: https://doi.org/10.1002/lio2.734
  5. Ravikumar N, Ho E, Wagh A, Murgu S. The role of bronchoscopy in the multidisciplinary approach to benign tracheal stenosis. J Thorac Dis. 2023;15(7):3998-4015. Epub 2023/08/10. doi: 10.21037/jtd-22-1734. PubMed PMID: 37559626; PubMed Central PMCID: PMCPMC10407490. DOI: https://doi.org/10.21037/jtd-22-1734
  6. Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981 Jan;70(1):65–76. 10.1016/0002-9343(81)90413-7 DOI: https://doi.org/10.1016/0002-9343(81)90413-7
  7. D'Andrilli A, Venuta F, Rendina EA. Subglottic tracheal stenosis. J Thorac Dis. 2016;8(Suppl 2):S140-7. Epub 2016/03/17. doi: 10.3978/j.issn.2072-1439.2016.02.03. PubMed PMID: 26981264; PubMed Central PMCID: PMCPMC4775266.
  8. Nouraei SA, Ma E, Patel A, Howard DJ, Sandhu GS. Estimating the population incidence of adult post-intubation laryngotracheal stenosis. Clin Otolaryngol. 2007 Oct;32(5):411–2. 10.1111/j.1749-4486.2007.01484.x DOI: https://doi.org/10.1111/j.1749-4486.2007.01484.x
  9. Zias N, Chroneou A, Tabba MK, Gonzalez AV, Gray AW, Lamb CR, et al. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med. 2008;8:18. Epub 2008/09/23. doi: 10.1186/1471-2466-8-18. PubMed PMID: 18803874; PubMed Central PMCID: PMCPMC2556644. DOI: https://doi.org/10.1186/1471-2466-8-18
  10. Valdez TA, Shapshay SM. Idiopathic subglottic stenosis revisited. Ann Otol Rhinol Laryngol. 2002 Aug;111(8):690–5. 10.1177/000348940211100806 DOI: https://doi.org/10.1177/000348940211100806
  11. Benjamin B, Jacobson I, Eckstein R. Idiopathic subglottic stenosis: diagnosis and endoscopic laser treatment. Ann Otol Rhinol Laryngol. 1997 Sep;106(9):770–4. 10.1177/000348949710600911 DOI: https://doi.org/10.1177/000348949710600911
  12. Pearson FG, Andrews MJ. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg. 1971 Oct;12(4):359–74. 10.1016/s0003-4975(10)65137-5 10.1016/S0003-4975(10)65137-5 DOI: https://doi.org/10.1016/S0003-4975(10)65137-5
  13. Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg. 1995 Mar;109(3):486–92. 10.1016/s0022-5223(95)70279-2 10.1016/S0022-5223(95)70279-2 DOI: https://doi.org/10.1016/S0022-5223(95)70279-2
  14. Amat B, Esselmann A, Reichle G, Rohde HJ, Westhoff M, Freitag L. The electrosurgical knife in an optimized intermittent cutting mode for the endoscopic treatment of benign web-like tracheobronchial stenosis. Arch Bronconeumol. 2012 Jan;48(1):14–21. 10.1016/j.arbres.2011.07.001 10.1016/j.arbr.2011.07.007 DOI: https://doi.org/10.1016/j.arbr.2011.07.007
  15. Grillo HC, Mathisen DJ. Surgical management of tracheal strictures. Surg Clin North Am. 1988 Jun;68(3):511–24. 10.1016/s0039-6109(16)44531-7 10.1016/S0039-6109(16)44531-7 DOI: https://doi.org/10.1016/S0039-6109(16)44531-7
  16. Wright CD, Li S, Geller AD, Lanuti M, Gaissert HA, Muniappan A, et al. Postintubation Tracheal Stenosis: management and Results 1993 to 2017. Ann Thorac Surg. 2019 Nov;108(5):1471–7. 10.1016/j.athoracsur.2019.05.050 DOI: https://doi.org/10.1016/j.athoracsur.2019.05.050
  17. Puri HV, Asaf BB, Mundale VV, Pulle MV, Bishnoi S, Munjal M, et al. Predictors of Anastomotic Complications After Resection and Anastomosis for Tracheal Stenosis. Indian J Otolaryngol Head Neck Surg. 2021;73(4):447-54. Epub 2021/10/26. doi: 10.1007/s12070-020-02238-5. PubMed PMID: 34692457; PubMed Central PMCID: PMCPMC8520546. DOI: https://doi.org/10.1007/s12070-020-02238-5
  18. Segura-Salguero JC, Díaz-Bohada L, Ruiz Á J. Perioperative management of patients undergoing tracheal resection and reconstruction: a retrospective observational study. Braz J Anesthesiol. 2022;72(3):331-7. Epub 2022/02/21. doi: 10.1016/j.bjane.2022.02.001. PubMed PMID: 35183604; PubMed Central PMCID: PMCPMC9373245. DOI: https://doi.org/10.1016/j.bjane.2022.02.001
  19. Macchiarini P, Verhoye JP, Chapelier A, Fadel E, Dartevelle P. Partial cricoidectomy with primary thyrotracheal anastomosis for postintubation subglottic stenosis. J Thorac Cardiovasc Surg. 2001 Jan;121(1):68–76. 10.1067/mtc.2001.111420 DOI: https://doi.org/10.1067/mtc.2001.111420
  20. Marulli G, Rizzardi G, Bortolotti L, Loy M, Breda C, Hamad AM, et al. Single-staged laryngotracheal resection and reconstruction for benign strictures in adults. Interact Cardiovasc Thorac Surg. 2008 Apr;7(2):227–30. 10.1510/icvts.2007.168054 DOI: https://doi.org/10.1510/icvts.2007.168054
  21. Menapace DC, Modest MC, Ekbom DC, Moore EJ, Edell ES, Kasperbauer JL. Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques. Otolaryngol Head Neck Surg. 2017 May;156(5):906–11. 10.1177/0194599817691955 DOI: https://doi.org/10.1177/0194599817691955
  22. Bibas BJ, Terra RM, Oliveira Junior AL, Tamagno MF, Minamoto H, Cardoso PF, et al. Predictors for postoperative complications after tracheal resection. Ann Thorac Surg. 2014 Jul;98(1):277–82. 10.1016/j.athoracsur.2014.03.019 DOI: https://doi.org/10.1016/j.athoracsur.2014.03.019
  23. Madariaga ML, Gaissert HA. Reresection for recurrent stenosis after primary tracheal repair. J Thorac Dis. 2016;8(Suppl 2):S153-9. Epub 2016/03/17. doi: 10.3978/j.issn.2072-1439.2016.01.66. PubMed PMID: 26981266; PubMed Central PMCID: PMCPMC4775269.
  24. Gelbard A, Anderson C, Berry LD, Amin MR, Benninger MS, Blumin JH, et al. Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg. 2020;146(1):20-9. Epub 2019/11/02. doi: 10.1001/jamaoto.2019.3022. PubMed PMID: 31670805; PubMed Central PMCID: PMCPMC6824232
  25. Shapshay SM, Beamis JF Jr, Hybels RL, Bohigian RK. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation. Ann Otol Rhinol Laryngol. 1987;96(6):661–4. 10.1177/000348948709600609 DOI: https://doi.org/10.1177/000348948709600609
  26. Myer CM 3rd, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994 Apr;103(4 Pt 1):319–23. 10.1177/000348949410300410 DOI: https://doi.org/10.1177/000348949410300410
  27. Ferreirinha J, Caviezel C, Weder W, Opitz I, Inci I. Postoperative outcome of tracheal resection in benign and malignant tracheal stenosis. Swiss Med Wkly. 2020 Dec;150:w20383. 10.4414/smw.2020.20383 DOI: https://doi.org/10.4414/smw.2020.20383
  28. Griffith BH. The treatment of keloids with triamcinolone acetonide. Plast Reconstr Surg. 1966 Sep;38(3):202–8. 10.1097/00006534-196609000-00004 DOI: https://doi.org/10.1097/00006534-196609000-00004
  29. Smith ME, Elstad M. Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one? Laryngoscope. 2009 Feb;119(2):272–83. 10.1002/lary.20056 DOI: https://doi.org/10.1002/lary.20056
  30. Schweinfurth JM. Endoscopic treatment of severe tracheal stenosis. Ann Otol Rhinol Laryngol. 2006 Jan;115(1):30–4. 10.1177/000348940611500105 DOI: https://doi.org/10.1177/000348940611500105
  31. Cataneo DC, Ximenes AM, Cataneo AJ. Mitomycin C in the endoscopic treatment of tracheal stenosis: a prospective cohort study. J Bras Pneumol. 2018;44(6):486-90. Epub 2019/02/07. doi: 10.1590/s1806-37562017000000423. PubMed PMID: 30726324; PubMed Central PMCID: PMCPMC6459742. DOI: https://doi.org/10.1590/s1806-37562017000000423
  32. Wierzbicka M, Tokarski M, Puszczewicz M, Szyfter W. The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology. J Laryngol Otol. 2016 Jul;130(7):674–9. 10.1017/s0022215116001122 10.1017/S0022215116001122 DOI: https://doi.org/10.1017/S0022215116001122
  33. Wei P, Huang Z, Gan L, Li Y, Qin C, Liu G. Nintedanib ameliorates tracheal stenosis by activating HDAC2 and suppressing IL-8 and VEGF in rabbit. Am J Transl Res. 2020;12(8):4739-48. Epub 2020/09/12. PubMed PMID: 32913546; PubMed Central PMCID: PMCPMC7476127.
  34. Fan Y, Li X, Fang X, Liu Y, Zhao S, Yu Z, et al. Antifibrotic Role of Nintedanib in Tracheal Stenosis After a Tracheal Wound. Laryngoscope. 2021 Sep;131(9):E2496–505. 10.1002/lary.29618 DOI: https://doi.org/10.1002/lary.29618
  35. Özdemir C, Kocatürk CI, Sökücü SN, Sezen BC, Kutluk AC, Bilen S, et al. Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach. Ann Thorac Cardiovasc Surg. 2018;24(6):288-95. Epub 2018/06/08. doi: 10.5761/atcs.oa.18-00073. PubMed PMID: 29877219; PubMed Central PMCID: PMCPMC6300420. DOI: https://doi.org/10.5761/atcs.oa.18-00073
  36. Gaissert HA, Grillo HC, Mathisen DJ, Wain JC. Temporary and permanent restoration of airway continuity with the tracheal T-tube. J Thorac Cardiovasc Surg. 1994 Feb;107(2):600–6. 10.1016/S0022-5223(94)70109-1 DOI: https://doi.org/10.1016/S0022-5223(94)70109-1
  37. Cui PC, Zhao DQ, Guo ZH, Liang LP, Wang W. [Effect of partial cricotracheal resection and extended cricotracheal resection for severe laryngotracheal stenosis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Feb;55(2):94–7. 10.3760/cma.j.issn.1673-0860.2020.02.003
  38. Brichet A, Verkindre C, Dupont J, Carlier ML, Darras J, Wurtz A, et al. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J. 1999 Apr;13(4):888–93. 10.1034/j.1399-3003.1999.13d32.x DOI: https://doi.org/10.1034/j.1399-3003.1999.13d32.x
  39. Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: prevention and treatment. J Thorac Dis. 2016;8(Suppl 2):S160-7. Epub 2016/03/17. doi: 10.3978/j.issn.2072-1439.2016.01.86. PubMed PMID: 26981267; PubMed Central PMCID: PMCPMC4775259.
  40. Donahue DM, Grillo HC, Wain JC, Wright CD, Mathisen DJ. Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis. J Thorac Cardiovasc Surg. 1997 Dec;114(6):934–8. 10.1016/s0022-5223(97)70007-2 10.1016/S0022-5223(97)70007-2 DOI: https://doi.org/10.1016/S0022-5223(97)70007-2

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