Multimodality endoscopic treatment for tracheobronchial stenosis secondary to endobronchial tuberculosis

Introduction: Tracheobronchial stenosis secondary to endobronchial tuberculosis (TSTB) is a rare but devastating complication of TB. Endoscopic interventions (EI) might be an attractive alternative for patients unfit for surgery but little is known on whether the efficacy of EI can be affected by airway features. Methods: Retrospective study of EI performed for TSTB patients at interventional pulmonology unit of Serdang Hospital, Malaysia. Results: Our cohort comprised of 9 patients with mean age of 33.9years (SD10.43). All had dyspnoea, 33% had stridor, 44% had cough. Of CT and bronchoscopy performed, 67% had tracheal stenosis, 44% right main bronchus involvement, 22% left main bronchus involvement. 33% had multilevel airway involvement. Of airway features, 67% had pure short segment membranous concentric stenosis. Remaining 33% had extra adverse airway features (22% bronchomalacia;11% thick fibrotic band). All cases were performed with rigid bronchoscopy under general anaesthesia. All underwent balloon dilatation of stenotic segment; 78% had topical mitomycin-c (TMC) application and 11% did mechanical coring of stenotic segment. Procedure was deemed successful (sustained symptomatic benefits of ≥3 months) in 67% cases. All unsuccessful cases had adverse airway features. Of complications, 22% developed self-limiting airway tear (0.5cm) during procedure. None developed TMC related complications. Conclusion: EI appears to be an attactive option for TSTB patients. We postulate that EI might produce more sustainable benefits in those with pure short membranous concentric stenosis without adverse airway features. Future studies are needed to define the exact role of EI for TSTB patients.

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