F Viveiros1, J Gomes, A Oliveira, S Neves, J Almeida, J Moura e Sá. 1. Unidade de Broncologia, Serviço de Pneumologia, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal. Electronic address: fcorreia@chvng.min-saude.pt.
Abstract
INTRODUCTION: Post-intubation tracheal stenosis (PITS) continues to be challenging in terms of diagnosis, management and prevention. Recurrence is common because of excessive granulation tissue formation and an insidious process of scar contracture. Topical application of mitomycin-C (MMC) as an adjuvant treatment for endoscopic management of stenosis has shown good results. The authors aimed to evaluate the results of MMC topical application following bronchoscopic dilatation as an adjuvant in PITS treatment. METHODS: Retrospectively selected patients with PITS who had had rigid bronchoscopy (RB) dilatation followed by MMC application as adjuvant to endoscopic treatment. MMC in a concentration of 0.4 mg/ml was applied with a cotton stiletto around the stenotic lesion and granulation tissue for 3 minutes. RESULTS: Eleven patients with PITS, with a median initial tracheal stenosis of 75% of the lumen, underwent RB/MMC treatment. Mean MMC sessions performed/patient was 3.5, with good response and prolonged decrease in granulation tissue formation in 55% of cases, moderate in 18% and relapse in 27%. Mean stenosis improvement was 34%. CONCLUSIONS: Topical MMC application at 0.4 mg/ml concentration seems to be associated with good results as adjuvant in PITS management with decrease in granulation tissue and sustained improvement in lumen diameter.
INTRODUCTION: Post-intubation tracheal stenosis (PITS) continues to be challenging in terms of diagnosis, management and prevention. Recurrence is common because of excessive granulation tissue formation and an insidious process of scar contracture. Topical application of mitomycin-C (MMC) as an adjuvant treatment for endoscopic management of stenosis has shown good results. The authors aimed to evaluate the results of MMC topical application following bronchoscopic dilatation as an adjuvant in PITS treatment. METHODS: Retrospectively selected patients with PITS who had had rigid bronchoscopy (RB) dilatation followed by MMC application as adjuvant to endoscopic treatment. MMC in a concentration of 0.4 mg/ml was applied with a cotton stiletto around the stenotic lesion and granulation tissue for 3 minutes. RESULTS: Eleven patients with PITS, with a median initial tracheal stenosis of 75% of the lumen, underwent RB/MMC treatment. Mean MMC sessions performed/patient was 3.5, with good response and prolonged decrease in granulation tissue formation in 55% of cases, moderate in 18% and relapse in 27%. Mean stenosis improvement was 34%. CONCLUSIONS: Topical MMC application at 0.4 mg/ml concentration seems to be associated with good results as adjuvant in PITS management with decrease in granulation tissue and sustained improvement in lumen diameter.
Authors: Mohamed Faisal; Hafaruzi Harun; Tidi M Hassan; Andrea Y L Ban; Sanjay H Chotirmall; Jamalul Azizi Abdul Rahaman Journal: BMC Pulm Med Date: 2016-04-14 Impact factor: 3.317