gms | German Medical Science

Introduction: The prevalence of tracheal stenosis (benign and malignant) has increased considerably the last two decades because of the better endoscopic evaluation and the large number of patients in intensive care units (long-term intubation and iatrogenic). Among treatment modalities, broncoscopy has appeared recently not only as a diagnostic tool but also as an alternative minimal invasive treatment modality in strictly selected patients.

Methods: From January 2000 to November 2008, in cooperation with the bronchoscopic department of Evangelismos Hospital, 34 patients with benign and malignant tracheal stenosis (22 with grade I and II stenosis and 12 with grade III and IV stenosis) were treated with dynamic bronchoscopy. In patients with grade I and II stenosis (granulomas, web-like stenosis), we performed 45 sessions of laser resection (KTP, Argon and Nd-Yag Laser) with dilatation (mean number per patient 2.1) and mitomycin injection. In patients with grade III and IV stenosis (8 malignancies and 4 tracheomalacias), 12 permanent silicon stents (Dumon type) were used.

Results: Success rate for patients with grade I and II stenosis was 75%. In 7 patients a silicon stent (Dumon type) was implanted because of recurrence after the third laser session. Recurrence after stent removal at 12 months was seen in 45% of patients and a second stent was then implanted. Success rate for patients with severe stenosis was 45%.

Conclusions: Bronchoscopy is not only a diagnostic tool but can be transformed in a first line therapy in selected cases of tracheal stenosis in order to avoid major operations such as tracheal resection. A close cooperation with the bronchoscopic department is always essential.