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Original Investigation
November 2016

Treatment of Benign Tracheal Stenosis Using Endoluminal Spray Cryotherapy

Author Affiliations
  • 1Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York
  • 2Department of Otolaryngology–Head and Neck Surgery, Mount Sinai West, Mount Sinai Health System, New York, New York
JAMA Otolaryngol Head Neck Surg. 2016;142(11):1082-1087. doi:10.1001/jamaoto.2016.2018
Key Points

Question  Is spray cryotherapy safe in patients with benign tracheal stenosis?

Findings  In this case series, spray cryotherapy was successful in improving airway patency in all patients, and no substantial intraoperative or postoperative complications were observed.

Meaning  Spray cryotherapy is a safe adjunct modality to accomplish airway patency in patients with benign tracheal stenosis and seems to prolong intervention-free interval.

Abstract

Importance  Tracheal stenosis is a debilitating disorder with heterogeneity in terms of disease characteristics and management. Repeated recurrences substantially alter patients’ quality of life. There is limited evidence for the use of spray cryotherapy (SCT) in the management of benign airway disease.

Objective  To report our early results for the use of SCT in patients with benign tracheal stenosis.

Design, Setting, and Participants  Data were extracted from the medical records of a consecutive series of patients with benign airway stenosis secondary to granulomatosis with polyangiitis (GPA) (n = 13), prior tracheotomy or tracheal intubation (n = 8), and idiopathic strictures (n = 5) treated from September 1, 2013, to September 30, 2015, at a tertiary care hospital.

Main Outcomes and Measures  Airway narrowing was quantified on a standard quartile grading scale. Response to treatment was assessed by improvement in airway caliber and the time interval for reintervention.

Exposures  Delivery of 4 5-second SCT cycles and 2 balloon dilatations.

Results  Twenty-six patients (median [range] age, 53 [16-83] years; 20 [77%] female) underwent 48 SCT sessions. Spray cryotherapy was successfully used without any substantial intraoperative or postoperative complications in all patients. In a median (range) follow-up of 11 (1-26) months, all patients had improvement in symptoms. Before the institution of SCT, 23 patients (88%) had grade III or IV stenosis. At the last evaluation after induction of SCT, 4 (15%) had grade III or IV stenosis, with a mean (SD) change of 1.39 (0.51) (P < .001). Patients with GPA required significantly fewer SCT procedures (mean [SD], 1.38 [0.96] vs 2.31 [1.18]; P = .03) during the study period.

Conclusions and Relevance  Spray cryotherapy was a safe adjunct modality to accomplish airway patency in patients with benign tracheal stenosis. Although efficacy evidence is limited for SCT, it may be useful for patients who have experienced treatment failure with conventional modalities. Further analysis of this cohort will determine the physiologic durability of the reported short-term changes. Additional trials are warranted for further evaluation of this modality.

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