Endoscopic treatment of severe tracheal stenosis

OBJECTIVES: Endoscopic treatment of subglottic and tracheal stenosis has traditionally been reserved for short-segment and web-like stenoses with normal cartilage. This retrospective case series review was undertaken to examine my experience with definitive endoscopic treatment for circumferential and complete tracheal stenosis with loss of cartilaginous support. METHODS: Patients who presented with tracheostomy dependence or dyspnea as a result of clinically significant tracheal stenosis over a 2-year period were treated endoscopically. Mitomycin C was applied after dilation in 19 patients. Three patients with complete stenosis and cartilage collapse underwent endoscopic placement of a silicone elastic stent, which was in place for less than 23 days. RESULTS: Twenty patients were treated for tracheal stenosis over a 2-year period. No surgical complications were observed after operation in the endoscopic treatment group. Three of 6 patients with complete stenoses and 8 of 10 patients with circumferential stenoses with cartilage involvement gained airways that remained patent. Nine patients' stenoses resolved after the initial treatment. Three patients (15%) eventually required tracheal resection. The follow-up periods ranged from 5 to 25 months. CONCLUSIONS: Although some limitations apply, severe and complete tracheal stenoses may be successfully treated endoscopically with the techniques described. Definitive endoscopic treatment may be considered before tracheal resection in select cases. Endoscopic treatment is associated with few complications, low morbidity, a short operative time, and a short length of hospitalization.