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Successful Bronchoscopic Balloon Dilation of Nonmalignant Tracheobronchial Obstruction Without Fluoroscopy^*

^* From the Washington University School of Medicine (Dr. Mayse), St. Louis, MO; Tulane University Health Sciences Center (Drs. Friedman and Kovitz), and Tulane University Hospital and Clinics (Ms. Greenheck), New Orleans, LA.

Correspondence to: Martin L. Mayse, MD, Assistant Professor of Medicine, Director of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mmayse{at}im.wustl.edu

Objective: To evaluate the safety and efficacy of bronchoscopic balloon dilation (BBD) without fluoroscopy for relief of tracheobronchial obstruction.

Methods: We performed a retrospective study of all adult patients who underwent BBD without fluoroscopy at the Tulane University Hospital and Clinic between July 1, 1997, and June 30, 2002.

Results: Twenty-four patients (mean [± SD] age, 58 ± 14 years; 80% men) underwent 59 BBD procedures without fluoroscopy for the following conditions: iatrogenic tracheal stenosis (80%); saber-sheath trachea (4%); bronchial stenosis resulting from lung transplantation (4%); sarcoidosis (4%); Wegener granulomatosis (4%); and idiopathic stenosis (4%). All BBD procedures were performed via a rigid bronchoscope (61%) or a flexible bronchoscope (39%) without fluoroscopy. BBD was often combined with mechanical debridement (64%), stent placement (47%), or laser photoresection (19%), although in 26% of cases BBD was the only intervention. During the 59 procedures, 71 different balloon catheters were deployed a total of 112 times (deployment was defined as any use of balloon dilation in a different location, for a different purpose, or to a different inflation diameter). These 112 deployments were performed for primary dilation (49%), dilation prior to stent placement (28%), and stent seating (22%). Improvement in stenosis was achieved immediately postprocedure in all 59 procedures (100%). One balloon ruptured during inflation without clinically significant effect, and no other complications occurred.

Conclusion: BBD without fluoroscopy for the relief of nonmalignant tracheobronchial obstruction can be safely performed through a rigid or flexible bronchoscope. It can be used alone or as an adjunct to other therapeutic modalities. In this series, 100% of airway obstructions were improved, and there were no clinically significant complications. BBD of a tracheobronchial obstruction without fluoroscopy is safe, efficacious, and cost-effective.

Key Words: airway obstruction • balloon dilation • bronchoplasty • bronchoscopy • fluoroscopy • stenosis

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