Fiberoptic bronchoscopic balloon dilatation in malignant tracheobronchial disease - Indications and results

Study objectives: Bronchoscopic balloon dilatatilon (BBD) has become a valuable tool in the treatment of benign tracheobronchial stenoses. The objective of this study was to assess indications for and results of fiberoptic BED in treating malignant lesions. Design: One hundred twenty-six balloon dilatation procedures were performed in 78 patients with predominantly bronchial carcinoma. BED was only performed when alternative modes of local treatment leg, laser therapy or stent implantation) were not indicated or were inappropriate. Indications were symptomatic stenoses of the tracheobronchial tree: dyspnea or strider (52%), retention pneumonia (15%), atelectasis (10%), retention of secretions (21%), or lung abscess (2%), Results: Fifty-five percent of all procedures consisted of dilatations of tracheal or bronchial lesions (group 1). In 22% of procedures, a stent was dilated (group 2), In 13%, BED was used to facilitate stent placement (group 3), and in 10% to enable the correct positioning of irradiation probes for brachytherapy (group 4), In group 1 and group 2, 2 of 2 lung abscesses resolved, 5 of 8 atelectases resolved, and II of 12 retention pneumonias resolved. Dyspnea improved in only 12 of 32 patients, No abscess recurred. Two pneumonias and two atelectases reappeared due to restenosis. Stent implantation and brachytherapy procedures were facilitated in 90% of cases. In 52% of cases, BED was supported by high-frequency jet ventilation. Complications consisted of one fatal hemoptysis caused by a lacerated pulmonary artery and minor bleeding not necessitating specific therapy. Conclusions: Fiberoptic BED is useful in the management of airway stents prior to and postimplantation, as well as in the placement of brachytherapy catheters,]BBD is also successful in the resolution of poststenotic lung abscesses, retention pneumonias, and atelectases.