title: A systematic review and meta-analysis of endoscopic balloon dilation of pediatric subglottic stenosis.
abstract: OBJECTIVE
  Endoscopic balloon dilation (EBD) is an inviting, noninvasive option to manage pediatric subglottic stenosis that could preclude the need for tracheostomy and/or laryngeal-tracheal reconstruction (LTR). However, treatment outcomes and patient selection criteria are not well described.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane databases were systematically searched using multiple search terms.
  
  
  METHODS
  A systematic review of pediatric EBD was performed and then reported in compliance with PRISMA principles. Inclusion criteria consisted of a sample size of 5 or greater, pediatric patients, and primary EBD without adjuvant procedures. Meta-analysis was performed with random effects modeling and pooled data regression.
  
  
  RESULTS
  After systematic database search and detailed review, 7 studies were included in the final data set with 150 total subjects. All studies were case series (level 4 evidence). The mean sample size was 20 subjects (range, 5-44), and the grand mean age was 2.2 years (range, 2.2-60 months). The random effects model estimate of the overall treatment success (avoidance of tracheostomy or LTR) was 65.3% (k = 6 studies, 95% confidence interval [CI] = 60.1%-70.6%, P < .001, Q test for heterogeneity = 3.98, P = .552, I(2) = 0%). Follow-up was inconsistently reported but averaged 4.6 months (range, 0.25-12.5 months). Only 1 study reported significant complications (1 death, 2 tracheal lacerations). Pooled data multivariate regression indicated that increasing Cotton-Meyers grade was associated with decreased odds of success (odds ratio = 0.198, 95% CI = 0.0451-0.870, P = .032). Funnel plot analysis suggested the possibility of publication bias.
  
  
  CONCLUSIONS
  EBD is successful in most patients over short-term follow-up. The reported complication rates are low. Increasing severity of subglottic stenosis increases the odds of treatment failure.
authors.affiliation: Uniformed Services University, Bethesda, Maryland, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lang
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brietzke
mesh_terms: D002648:Child; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D058753:Laryngoplasty / Q000379:methods*; D007829:Laryngostenosis / Q000601:surgery*; D015999:Multivariate Analysis; D016896:Treatment Outcome
keywords: balloon dilation; subglottic stenosis; systematic review meta-analysis