AABIP IP Fellow Reading List

Non-Malignant Airway Disease and Management

The diagnosis and management of airway complications following lung transplantation

https://pubmed.ncbi.nlm.nih.gov/28274791/

Review

Reference: Mahajan AK, Folch E, Khandhar SJ, et al. The diagnosis and management of airway complications following lung transplantation. Chest. 2017;152(3):627-638.

Summary: Airway complications after lung transplantation can lead to significant morbidity and mortality. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation. It also reviews the multiple grading systems for bronchial healing and describes different bronchoscopic modalities that can be employed. There are treatment algorithms for obstructive pathologies, bronchial stenosis, bronchomalacia and anastomotic dehiscence.

Multi-disciplinary management of patients with benign airway strictures: A review

https://pubmed.ncbi.nlm.nih.gov/34481304/

Review

Reference: Agrawal A, Baird BJ, Madariaga MLL, Blair EA, Murgu S. Multi-disciplinary management of patients with benign airway strictures: A review. Respir Med. 2021;187:106582.

Summary: The optimal management of patients with benign airway strictures requires the availability, expertise and collaboration of otolaryngologists, thoracic surgeons, and interventional pulmonologists. This review articles highlights the classification system for laryngotracheal stenosis and the etiology of benign airway stenosis. It concludes with various therapeutic options that can be employed for mitigation of stenosis based on anatomy and location of stenosis.

Safety and efficacy of a fully covered self-expandable metallic stent in benign airway stenosis

https://pubmed.ncbi.nlm.nih.gov/28448981/

Retrospective

Reference: Fortin M, Lacasse Y, Elharrar X, et al. Safety and efficacy of a fully covered self-expandable metallic stent in benign airway stenosis. Respiration. 2017;93(6):430-435.

Background: SEMS (Self expandable metallic stents) have a black box warning for use in benign airway disease due to risk of stent related complications and difficulties with removal. This study examines the safety and efficacy of a specific third-generation SEMS, the Silmet stent.

PICO:

Population –

  • Patients with benign airway stenosis (n = 30)

Intervention –

  • 40 SEMS inserted for airway stenosis

Comparison –

  • None

Outcome –

  • 50% of stents were removed because of stent-related complications with median time to removal 77.0 ± 96.6 days 
  • Complications - Migration 32.5%, granulation tissue formation 7.5%, subjective intolerance 5%, mucus plugging 2.5%, laryngeal edema 2.5%.
  • All complications were successfully managed endoscopically 
  • The clinical success rate of stent treatment was 40.7%. This was defined as a stent left in place indefinitely without complication or a stent removal trial without further intervention for 1 year.
  • No cases of stent-related mortality
  • Thirty-six stents (90%) were removed successfully after a median of 122 ± 113.2 days without any complications

Take home: Third-generation SEMS are a safe treatment option for complex benign airway stenosis, but complications requiring stent removal are frequent

Treatment of benign tracheal stenosis using endoluminal spray cryotherapy

https://pubmed.ncbi.nlm.nih.gov/27532803/  

Clinical Trial  

Reference: Bhora FY, Ayub A, Forleiter CM, et al. Treatment of benign tracheal stenosis using endoluminal spray cryotherapy. JAMA Otolaryngol Head Neck Surg. 2016;142(11):1082-1087.

Background: This study reports the experience of a single institution using spray cryotherapy (SCT) in the management of benign tracheal stenosis.

PICO:

Population – 

  • 26 patients with benign tracheal stenosis (13 due to granulomatosis with polyangiitis, 8 due to prior tracheotomy/endotracheal intubation, and 5 that were idiopathic)

Intervention – 

  • Use of spray cryotherapy. Delivery of four, 5-second SCT cycles and two balloon dilations

Comparison – 

  • None

Outcome – 

  • 96% of patients had undergone prior non-SCT endoscopic treatments
  • 88% of patients had grade III or IV stenosis 
  • 48 cryotherapy treatments were administered to 26 patients who were followed for a median of 11 months
  • All patients reported improvement in their breathing
  • Only 15% of patients had a residual grade III or IV stenosis at their most recent follow-up
Take home: Spray cryotherapy is a newer technique that is safe and generally effective in the management of benign tracheal stenosis. Given the paucity of data on its use, particularly with long-term outcomes, SCTs current role may be limited to patients who have failed conventional therapies.