Source: Annual Congress 2009 - How to deal with tracheal stenosis

Abstract

SGS develops in approximately 16-23% of patients with Wegener‘s granulomatosis disease (Langford et al ,1996). Endoscopic procedures are indeed an important treatment option for this complication and its relapses. We retrospectively examined short and longterm efficacy as well as safety of endoscopic management of SGS with laser assisted mechanical dilatation and/or intralesional injection of long-acting corticosteroid (methylprednisolone acetate) into the stenotic segment . We reviewed data from all patients with Wegener‘s granulomatosis referring to our institution since 1999. They all showed symptoms of upper airway obstruction or at least 50% obstruction in the subglottis region. Procedures were repeated if re-stenosis occurred. A group of 7 patients (5 F; age range:21-55 yrs) underwent 44 procedures (19 intralesional injection, 24 laser assisted mechanical dilatation and 1 both procedures). Mean follow-up was 65 ± 39 months. Patients required a mean of 6.4 procedures at mean intervals of 8.9 months to maintain subglottic patency. None of the 7 patients required tracheotomy or more aggressive surgical treatments(segmental resection of SGS with primary anastomotic reconstruction). Moreover, there were no complications and adverse longterm sequelae. Our results confirm that SGS and its relapses in patients with Wegener‘s granulomatosis should be managed primarily by endoscopic procedures.

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R. D‘Ippolito, L. Fecci, M. Majori, A. Vaglio, I. Casazza, A. G. Casalini (Parma, Italy). Management of subglottic stenosis (sgs) with endoscopic procedures in patients with Wegener‘s granulomatosis. Eur Respir J 2009; 34: Suppl. 53, 4237

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