Bronchoscopic management of tracheo-bronchial stenosis due to tuberculosis : A retrospective study in a tertiary care hospital in India

S. Jain*^a (Dr), V. Nanda^a (Dr), M. Pilaniya^a (Dr), S. Gupta^a (Dr)

^a Ramkrishna Care Hospital, Raipur, INDIA

* drsushiljain01@gmail.com

Background : Tracheo-bronchial stenosis due to tuberculosis (TSTB) is a rare complication of endobronchial TB. Despite the decline in pulmonary tuberculosis with the advent of effective chemotherapy, TSTB continues to be under-recognized, under-diagnosed and often misdiagnosed. Surgical treatment had been advocated to be the best modality for treatment of these cases. However, there are studies which suggests that bronchoscopic treatment of TSTB can be done with good results.

Methods : We present our experience of bronchoscopic management of tracheo-bronchial stenosis due to tuberculosis (TSTB), over a period of 3 years (2019-2021). During this period we had 9 patients with tracheo-bronchial stenosis due to tuberculosis, who were treated by flexible bronchoscopic dilatation in our department. These patients were aged between 16 to 47 years. 6 patients were male and 3 patients were female. 4 patients had left main bronchial stenosis (2 of them also had left upper lobe bronchial stenosis and 1 had lower tracheal stenosis), 1 patient had right main bronchial stenosis, 2 patients had left upper lobe bronchial stenosis, 1 patient had right upper lobe bronchial stenosis and 1 patient had right middle lobe bronchial stenosis. All patients underwent flexible bronchoscopic dilatation of the tracheo-bronchial stenosis successfully. Mercedes-Benz incision was done in 5 cases with web-like stenosis of the bronchus. Serial CRE balloon dilatation was done in all cases. Mitomycin-C was applied locally in all patients post-dilatation.

Results : All patients with tracheo-bronchial stenosis due to tuberculosis could be successfully treated by bronchoscopic dilatation. None of these patients had any post-procedural complications.

Conclusion : Bronchoscopic dilatation is an effective treatment option for patients with tracheo-bronchial stenosis due to tuberculosis (TSTB). Large prospective studies are needed to assess the long term outcome of this treatment.

Disclosure of funding source(s): none