Flexible bronchoscopy balloon dilation
- Henri G Colt, MD
Henri G Colt, MD
- Professor of Medicine
- University of California Irvine
Benign tracheobronchial stenosis of the proximal airways can result from a variety of conditions and can cause dyspnea, cough, wheeze, stridor, or recurrent pulmonary infections. A variety of modalities may be used to manage benign airway strictures, but none is documented to be uniformly effective [1-5]. The technique of flexible balloon dilation for treating benign airway strictures (bronchoplasty) will be reviewed here. Other techniques for treating these lesions are discussed separately. (See "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults".)
The successful use of a balloon to dilate a benign airway stricture was first reported in an 18-week infant with a post-surgical stricture . Several uses of the technique were reported in the following years for strictures related to prolonged intubation , sleeve resection with bronchial reimplantation , endobronchial granuloma due to an aspirated pill fragment, and recurrent squamous cell carcinoma following radiation therapy .
These initial reports utilized fluoroscopy or rigid bronchoscopy to guide the dilation procedure. Flexible bronchoscopy with balloon dilation was not described until 1991 , and since that time relatively few reports with small numbers of patients have been published [11-19].
ETIOLOGY OF STRICTURES
Subacute airway compromise results most commonly as a complication of bronchogenic carcinoma, but balloon dilation provides only limited palliation in this setting . However, the technique is useful in the treatment of benign strictures due to a number of conditions, including:
●Sequelae of long-term endotracheal intubation or tracheotomy 
- Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002; 19:356.
- Ernst A, Silvestri GA, Johnstone D, American College of Chest Physicians. Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians. Chest 2003; 123:1693.
- Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004; 169:1278.
- Mehta AC, Harris RJ, De Boer GE. Endoscopic management of benign airway stenosis. Clin Chest Med 1995; 16:401.
- Prakash UB. Advances in bronchoscopic procedures. Chest 1999; 116:1403.
- Cohen MD, Weber TR, Rao CC. Balloon dilatation of tracheal and bronchial stenosis. AJR Am J Roentgenol 1984; 142:477.
- Groff DB, Allen JK. Gruentzig balloon catheter dilation for acquired bronchial stenosis in an infant. Ann Thorac Surg 1985; 39:379.
- Fowler CL, Aaland MO, Harris FL. Dilatation of bronchial stenosis with Gruentzig balloon. J Thorac Cardiovasc Surg 1987; 93:308.
- Carlin BW, Harrell JH 2nd, Moser KM. The treatment of endobronchial stenosis using balloon catheter dilatation. Chest 1988; 93:1148.
- Nakamura K, Terada N, Ohi M, et al. Tuberculous bronchial stenosis: treatment with balloon bronchoplasty. AJR Am J Roentgenol 1991; 157:1187.
- Hautmann H, Gamarra F, Pfeifer KJ, Huber RM. Fiberoptic bronchoscopic balloon dilatation in malignant tracheobronchial disease: indications and results. Chest 2001; 120:43.
- Noppen M, Schlesser M, Meysman M, et al. Bronchoscopic balloon dilatation in the combined management of postintubation stenosis of the trachea in adults. Chest 1997; 112:1136.
- Girard P, Baldeyrou P, Lemoine G, Grunewald D. Left main-stem bronchial stenosis complicating bronchial artery embolization. Chest 1990; 97:1246.
- Ball JB, Delaney JC, Evans CC, et al. Endoscopic bougie and balloon dilatation of multiple bronchial stenoses: 10 year follow up. Thorax 1991; 46:933.
- Keller C, Frost A. Fiberoptic bronchoplasty. Description of a simple adjunct technique for the management of bronchial stenosis following lung transplantation. Chest 1992; 102:995.
- Carré P, Rousseau H, Lombart L, et al. Balloon dilatation and self-expanding metal Wallstent insertion. For management of bronchostenosis following lung transplantation. The Toulouse Lung Transplantation Group. Chest 1994; 105:343.
- Fouty BW, Pomeranz M, Thigpen TP, Martin RJ. Dilatation of bronchial stenoses due to sarcoidosis using a flexible fiberoptic bronchoscope. Chest 1994; 106:677.
- Ferretti G, Jouvan FB, Thony F, et al. Benign noninflammatory bronchial stenosis: treatment with balloon dilation. Radiology 1995; 196:831.
- Mayse ML, Greenheck J, Friedman M, Kovitz KL. Successful bronchoscopic balloon dilation of nonmalignant tracheobronchial obstruction without fluoroscopy. Chest 2004; 126:634.
- Vansteenkiste JF, Lacquet LM. Possibilities and indications for Nd-YAG laser and dilation therapy in the management of tracheal stenosis. Acta Otorhinolaryngol Belg 1995; 49:359.
- Brown SB, Hedlund GL, Glasier CM, et al. Tracheobronchial stenosis in infants: successful balloon dilation therapy. Radiology 1987; 164:475.
- Wilson, NJ. Bronchoscopic observations in tuberculous tracheobronchitis: Clinical and pathological correlation. Dis Chest 1945; 11:36.
- Bugher, JC, Littig, J, Culp, J. Tuberculous tracheobronchitis: Its pathogenesis. Am J Med Sci 1937; 193:515.
- AUERBACH O. Tuberculosis of the trachea and major bronchi. Am Rev Tuberc 1949; 60:604.
- Eloesser, L. Bronchial stenosis in pulmonary tuberculosis with some notes on tuberculous stenosis of the trachea and the bronchioles. Am Rev Tuberc 1934; 30:123.
- Salkin, D Cadden, AV, Edson, RC. The natural history of tuberculous tracheobronchitis. Am Rev Tuberc 1943; 47:351.
- JUDD AR. Tuberculous tracheobronchitis; a study of 500 consecutive cases. J Thorac Surg 1947; 16:512.
- Dumon JF. YAG Laser bronchoscopy, Praeger Publishers, New York 1985. p.117.
- Elkerbout SC, van Lingen RA, Gerritsen J, Roorda RJ. Endoscopic balloon dilatation of acquired airway stenosis in newborn infants: a promising treatment. Arch Dis Child 1993; 68:37.
- Tanahashi M, Niwa H, Yukiue H et al. Global perspectives on bronchoscopy. Bronchoscopic balloon dilation for benign tracheobronchial stenosis. www.intechopen.com (Accessed on May 26, 2015).
- Kim JH, Shin JH, Song HY, et al. Tracheobronchial laceration after balloon dilation for benign strictures: incidence and clinical significance. Chest 2007; 131:1114.
- Kim JH, Shin JH, Shim TS, et al. Deep tracheal laceration after balloon dilation for benign tracheobronchial stenosis: case reports of two patients. Br J Radiol 2006; 79:529.
- Hebra A, Powell DD, Smith CD, Othersen HB Jr. Balloon tracheoplasty in children: results of a 15-year experience. J Pediatr Surg 1991; 26:957.
- Sheski FD, Mathur PN. Long-term results of fiberoptic bronchoscopic balloon dilation in the management of benign tracheobronchial stenosis. Chest 1998; 114:796.
- Cho YC, Kim JH, Park JH, et al. Tuberculous Tracheobronchial Strictures Treated with Balloon Dilation: A Single-Center Experience in 113 Patients during a 17-year Period. Radiology 2015; 277:286.
- Grillo HC, Mathisen DJ. Surgical management of tracheal strictures. Surg Clin North Am 1988; 68:511.
- Iles PB. Multiple bronchial stenoses: treatment by mechanical dilatation. Thorax 1981; 36:784.
- Mehta AC, Lee FY, Cordasco EM, et al. Concentric tracheal and subglottic stenosis. Management using the Nd-YAG laser for mucosal sparing followed by gentle dilatation. Chest 1993; 104:673.
- Dumon JF, Reboud E, Garbe L, et al. Treatment of tracheobronchial lesions by laser photoresection. Chest 1982; 81:278.
- Mathur PN, Wolf KM, Busk MF, et al. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest 1996; 110:718.