Role of bronchoscopic interventions in the management of patients with tuberculosis related airway complications

S. Goyal*^a (Dr), A. Jindal^a (Dr), K. Kumar^a (Mr), D. Dutt^a (Mr), J. Khan^a (Mr)

^a Artemis Hospitals, Gurugram, INDIA

* shivanshu.goyal@gmail.com

Background:

Tuberculosis (TB) is one of the most concerning infectious diseases and a leading cause of morbidity plus mortality worldwide; specially in endemic regions like India. We hereby present our experience of case scenarios to assess role of bronchoscopic interventions in management of airway complications secondary to tuberculosis.

Methods:

Total of fifteen (n=15) patients who presented over a period of 18 months to a tertiary care medical center at North India with TB related airway complications were included. They underwent bronchoscopic interventions including balloon dilatation, stent placement, electrocautery, holmium laser resection, debulking of tumourous endobronchial TB, argon plasma coagulation (APC), cryotherapy, amplatzer ASD closure device insertion, bronchial blocker and endobronchial watanabe spigot (EWS) insertion. Post procedure follow up period was 12 months.

Results:

Bronchoscopic interventions provided early improvement clinically and radiologically in more than 90% of patients. Five patients presented with tracheobronchial stenosis; four after dilatation underwent stent placement (1: Silicone; 3: SEMS), whereas one patient only underwent balloon dilatation. Two patients had endobronchial debulking procedure; one with rigid bronchoscope other with APC probe. In two patients with TB related tracheo-oesophageal fistulae (both found unfit for surgery): one was managed with fully covered SEMS and other with an ASD closure device. Three patients with secondary bronchopleural fistulae (BPF); after leak localisation had undergone EWS insertion bronchoscopically. Out of 3 patients with active haemoptysis; two were managed with cryotherapy and in other bronchial blocker folllowed by bronchial artery embolisation (BAE). No procedural complications noted and most patients had good results on follow up apart from one who developed extensive granulation tissue around SEMS.

Conclusion:

Bronchoscopic interventions are useful, less invasive and more feasible than surgery for management of TB related airway complications and sequelae. This modality should be utilised as adjunct to an adequately dosed, complete anti-TB treatment short course.

Disclosure of funding source(s): none