Fiberoptic bronchoscopic balloon dilatation in malignant tracheobronchial disease - Indications and results

Study objectives: Bronchoscopic balloon dilatatilon (BBD) has become a valu able tool in the treatment of benign tracheobronchial stenoses. The objecti ve of this study was to assess indications for and results of fiberoptic BE D in treating malignant lesions. Design: One hundred twenty-six balloon dilatation procedures were performed in 78 patients with predominantly bronchial carcinoma. BED was only perfor med when alternative modes of local treatment leg, laser therapy or stent i mplantation) were not indicated or were inappropriate. Indications were sym ptomatic stenoses of the tracheobronchial tree: dyspnea or strider (52%), r etention pneumonia (15%), atelectasis (10%), retention of secretions (21%), or lung abscess (2%), Results: Fifty-five percent of all procedures consisted of dilatations of t racheal or bronchial lesions (group 1). In 22% of procedures, a stent was d ilated (group 2), In 13%, BED was used to facilitate stent placement (group 3), and in 10% to enable the correct positioning of irradiation probes for brachytherapy (group 4), In group 1 and group 2, 2 of 2 lung abscesses res olved, 5 of 8 atelectases resolved, and II of 12 retention pneumonias resol ved. Dyspnea improved in only 12 of 32 patients, No abscess recurred. Two p neumonias and two atelectases reappeared due to restenosis. Stent implantat ion and brachytherapy procedures were facilitated in 90% of cases. In 52% o f cases, BED was supported by high-frequency jet ventilation. Complications consisted of one fatal hemoptysis caused by a lacerated pulmonary artery a nd minor bleeding not necessitating specific therapy. Conclusions: Fiberoptic BED is useful in the management of airway stents pr ior to and postimplantation, as well as in the placement of brachytherapy c atheters,]BBD is also successful in the resolution of poststenotic lung abs cesses, retention pneumonias, and atelectases.