Long-Term Results of Endoscopic Dilatation for Tracheal and Subglottic Stenosis

OBJECTIVES: The purpose of this study was to assess the long-term results of endoscopic dilatation of airway stenosis and to evaluate predictive factors for favorable results. METHODS: Fifty-four patients with tracheal and subglottic stenosis who underwent endoscopic dilatation with at least 12 months follow-up were enrolled in this study. We evaluated predictive factors for final treatment outcome such as stenosis length, location, characteristics, procedure type, and the severity of stenosis. RESULTS: The final outcome of endoscopic dilatation showed a cure rate of 40.7%, improvement rate of 46.3%, and failure rate of 13.0%. Patients with mild stenosis or a shorter stenotic segment and those who underwent a touch-up procedure following tracheal resection with end-to-end anastomosis showed better outcomes. The cure rate of endoscopic dilatation for patients with shorter mild stenosis was 72.2%. CONCLUSION: Endoscopic dilatation may be a primary treatment modality for patients with airway stenosis characterized by mild severity and a short stenotic segment.

Estenosis traqueal sintomática post intubación: análisis espirométrico pre y post dilatación terapéutica / Symptomatic post intubation tracheal stenosis: analysis pre and post spirometry therapeutic dilatation

Introducción: La estenosis traqueal (ET) es una complicación de la intubación traqueal o de la traqueostomía. La dilatación con endoscopía rígida (DER) es el tratamiento inicial en presencia de ET sintomática. Habitualmente estos pacientes presentan hallazgosespirométricos sugestivos de ET: aplanamiento en las ramas inspiratoria, espiratoria o ambas de la curva flujo-volumen (CFV). Asimismo, índices numéricos correlacionan valores espirométricos y sustentan el diagnóstico presuntivo de ET. Objetivos: Evaluar las características espirométricas de los pacientes con ET post intubación, previo y posterior a la DER. Materiales y métodos: Se analizaron todas las DER realizadasen pacientes con ET entre Noviembre de 2006 y Marzo de 2009. Todos los pacientes incluidos contaban con espirometría previa y posterior a la DER. Se analizó el volumen espiratorio forzado en 1° segundo (VEF1), pico flujo espiratorio (PFE), índice VEF1/PFEy la morfología de la CFV. Resultados: Veinticinco dilataciones traqueales fueron realizadas en 15 pacientes con ET. Posterior a la DER se observó un incremento en el VEF1 y PEF (total y %), así como una disminución en el índice VEF1/PEF. La CFV mostró un mayor área bajo la curva como consecuencia de menor aplanamiento de una o ambas ramas. Conclusiones: La espirometria pre-dilatación confirmó el diagnóstico de ET utilizando el VEF1, PEF y su índice (análisis numérico). La morfología de la CFV sustentó dicho diagnostico (análisis visual). La espirometría post-dilatación permitióobjetivar la mejoría de la ET a través de ambos tipos de parámetros, coincidiendo con el aumento del diámetro traqueal observado endoscópicamente.

Introduction: Tracheal stenosis (TS) is a complication of endotracheal intubation or tracheostomy. Rigid endoscopic dilatation (RED) is the initial treatment in symptomatic TS. Usually these patients have spirometric results that suggest such alteration: flatteningof the flow-volume curve (FVC), either in the espiratory, the inspiratory or bothcurves. Also, quantitative indexes among different spirometric values are correlated suggesting the presence of TS. Objectives: To assess spirometric characteristics in patients who suffer from symptomatic TS due to airway intubation, before and after therapeutic RED. Materials and methods: All RED procedures in patients with symptomatic TS performed between November 2006 and March 2009 were included in the analysis. All included patients should have a spirometry performed before andafter tracheal dilatation. Forced expiratory volume in 1st second (FEV1), peak expiratory flow rate (PEFR), FEV1/PEFR index and FVC morphology were taken into consideration. Results: Twenty five ED were performed in 15 patients with TS. An increase in FEV1(total and %) and PEFR (total and %) and a decrease in FEV1/PEFR index were observed in the post-dilatation values. The FVC showed an improvement in its morphology through a larger area under the curve because of less flattening in one or both curves.Conclusions: Pre-dilatation spirometry confirmed TS diagnosis using FEV1, PEFR and its index (quantitative analysis) and by the morphology of the FVC (visual analysis). Post-dilatation spirometry allowed the documentation of TS improvement through both kinds of parameters, in agreement with the improvement of the luminal diameter seen endoscopically.

Factors Affecting the Response to Endoscopic Dilatation Therapy for Benign Esophageal Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic dilatation is an effective therapy for benign esophageal stricture. We analyzed the factors related to the endoscopic dilatation therapy in patients with benign esophageal strictures such as etiology, grade of dysphagia, length of stricture and number of therapeutic sessions. METHODS: We retrospectively analyzed the data of 63 patients who received endoscopic esophageal dilatation therapy due to benign esphageal strictures. RESULTS: The grade of dysphagia number was associated with the length of strictures (p=0.012) and therapeutic session (p=0.005). There was a statistically significant correlation between the length of strictures and therapeutic session number (p=0.001). There was no statistical difference in grade of dysphagia or the length of stricture according to the cause of strictures of therapeutic sessions performed. In corrosive stricture, the higher grade of dysphagia, was associated with the in creased number (p=0.028). The length of stricture was longer (p=0.040) and the number of therapeutic sessions were increased (p=0.026) in corrosive stricture than other etiologies. CONCLUSIONS: Corrosive esophageal stricture shows long stricture segment and needs increased number of therapeutic session as compared to other etiologies. However, corrosive esophageal stricture can be effectively treated with careful technique and increased number of endoscopic dilatation sessions.