Using insulation-tipped knife for rigid bronchoscopic dilatation of benign tracheobronchial stenosis
JE. Hana (Dr), C. Kim*a (Dr)
a Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, KOREA, REPUBLIC OF
Background: Tracheal or bronchial laceration is a potential complication of rigid bronchoscopy. This study aimed to investigate the acute complications and outcomes of using an insulation-tipped (IT) knife in combination with rigid bronchoscopic dilatation for treating benign tracheobronchial stenosis.
Methods: We conducted a chart review of patients with benign tracheobronchial stenosis who were treated with rigid bronchoscopy and an IT knife at two referral centers. Treatment success was defined as a clinically stable state without worsening symptoms after 3 months of treatment.
Results: Of the 23 patients with benign tracheobronchial stenosis, 15 had tracheal stenosis and 6 had main bronchial stenosis. Among them, three cases were of simple stenosis (13%), while the others were of complex stenosis (87%). The overall treatment success rate was 87.0%. Pneumomediastinum and subcutaneous emphysema occurred due to bronchial laceration in two cases of distal left main bronchial stenosis (8.7%), and no other significant acute complications developed. Silicone stents were inserted in 20 patients, and successful stent removal was possible in 11 patients (55.0%). Six of the seven stents inserted in patients with post-intubation tracheal stenosis were removed successfully (85.7%). However, most of the patients with post-tracheostomy tracheal stenosis required persistent stenting (80%). Pulmonary function was significantly increased after treatment, and the mean increase in the forced expiratory volume in 1 s was 391 ± 171 mL (160-700 mL).
Conclusion: The combined use of an IT knife with rigid bronchoscopy can be suggested as an effective and safe modality for treatment of benign tracheobronchial stenosis. This technique may help in loosening the dense fibrotic stenosis and facilitate mechanical bougienage with a lower risk of airway injury.
Disclosure of funding source(s): none