Bronchoscopic balloon dilatation in the management of bronchial stenosis following lung transplantation.
BACKGROUND
Bronchial stenosis (BS) is currently found in 7-15% of lung transplantation (LT) recipients. Current treatment strategies have included Nd:Yag laser, cryotherapy, bougie dilatation and stent placement. Bronchoscopic balloon dilatation has been used as alternative treatment in a few cases with controversial results. This is a study to prospectively assess the efficacy of bronchoscopic balloon dilatation as a first step in the management of post-LT BS.


METHODS
From January 1995 to December 2002, bronchoscopic balloon dilatation was evaluated as first therapeutic option in all consecutive LT patients with BS. Symptoms, pulmonary function tests, airway diameter and use of other therapeutic techniques were evaluated.


RESULTS
A total of 10 out of 284 anastomed airways (3.5%) in 9 out of 152 LT patients were included in the study and follow-up lasted from 6 to 81 months. Dilatation of all but one BS met with initial success: increase of both luminal dimensions and forced vital capacity (P=0.01), and relief of symptoms. Bronchoscopic balloon dilatation long-term follow-up showed effective results in 5 out of 10 (50%) bronchial stenoses, after an average of 4 bronchoscopic balloon dilatation procedures (range 1-8). No severe complications were observed. Stent placement was required in the other 5 bronchial stenoses.


CONCLUSIONS
Bronchoscopic balloon dilatation is a safe method that should be considered as first therapeutic treatment of post-LT BS. Its use avoids the need for stent placement in up to 50% of cases.
De Gracia
J
J
Department of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. jgracia@separ.es
Culebras
M
M
Alvarez
A
A
Catalán
E
E
De la Rosa
D
D
Maestre
J
J
Canela
M
M
Román
A
A
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001980:Bronchi / Q000473:pathology*; D001982:Bronchial Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001999:Bronchoscopy; D002404:Catheterization; D016009:Chi-Square Distribution; D002648:Child; D003251:Constriction, Pathologic; D005260:Female; D005336:Fiber Optic Technology; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000503:physiopathology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D015607:Stents