title: Feasibility of spray cryotherapy and balloon dilation for non-malignant strictures of the airway.
abstract: OBJECTIVE
  Benign airway strictures can be complex and challenging to manage. Although resection is preferred, this is not always feasible, and hence, endoscopic therapies are often performed. However, endoscopic therapies can be problematic, with granulation tissue and fibrosis leading to early failure. Spray cryotherapy (SC) is a new approach that may modulate the healing response leading to less fibrosis and decrease the need or the duration of time to intervention. We report the initial results of SC for benign airway strictures.
  
  
  METHODS
  Over a 22-month period, 35 patients underwent SC. Median age was 51(18-81) years. Prior therapy had been undertaken in 14 (41.2%) of patients. Stricture etiology included post intubation (n=5), prior tracheostomy (n=6), radiation induced (n=2), prior surgery (n=3), other causes (n=12), or unknown etiology (n=7). Airway narrowing was graded as follows: 1=0-25%, 2=26-50%, 3=51-75%, and 4=76-100%. For the purpose of analysis, this was treated as a continuous variable. The usual treatment algorithm consisted of ×3-4 SC cycles, followed by balloon dilation, and then by additional SC cycles.
  
  
  RESULTS
  Stricture locations were subglottic (n=18), tracheal (n=9), and bronchial (n=8). Seventeen (49%) patients required additional SC therapy, resulting in a total of 63 SC treatment sessions. Only two (3.2%) complications occurred and these included pneumothorax (n=1) and intra-operative tracheostomy (n=1). Mean follow-up was available in 33/35 patients at a mean of 8.2 (1-19) months. Twelve (of 33) patients (36.4%) were asymptomatic, 16/33 (48.5%) were improved, 4/33(12.1%) had no improvement or were worse, and 1/33(3%) patient died from an unrelated cancer. On follow-up bronchoscopy, performed in 28 patients, airway narrowing improved significantly from 3.5 to 2.03 (p<0.001).
  
  
  CONCLUSIONS
  Initial experience with SC for benign airway strictures suggests that this can be used safely. This is effective in improving symptoms and reducing the severity of airway narrowing. Re-intervention is still required. Further study should be undertaken to determine factors that may be associated with success or failure as well as the relative efficacy of SC compared with other endoscopic therapies.
authors.affiliation: Department of Cardiothoracic Surgery, Boston Medical Center, Boston University, Boston, MA, USA. hiran.fernando@bmc.org
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
authors.forename: Dominic
authors.initials: D
authors.lastname: Dekeratry
authors.forename: Gordon
authors.initials: G
authors.lastname: Downie
authors.forename: David
authors.initials: D
authors.lastname: Finley
authors.forename: Vita
authors.initials: V
authors.lastname: Sullivan
authors.forename: Saiyad
authors.initials: S
authors.lastname: Sarkar
authors.forename: Roberto
authors.initials: R
authors.lastname: Rivas
authors.forename: Ricardo Sales Dos
authors.initials: RS
authors.lastname: Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000628:therapy*; D001982:Bronchial Diseases / Q000628:therapy; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000628:therapy; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007829:Laryngostenosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D014135:Tracheal Stenosis / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult