0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Treatment of Benign Tracheal Stenosis Using Endoluminal Spray Cryotherapy ONLINE FIRST

Faiz Y. Bhora, MD1; Adil Ayub, MD1; Craig M. Forleiter, MD1; Chyun-Yin Huang, MD1; Khalid Alshehri, MD1; Sadiq Rehmani, MD1; Adnan M. Al-Ayoubi, MD, PhD1; Wissam Raad, MD1; Robert S. Lebovics, MD2
[+] 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. Published online August 11, 2016. doi:10.1001/jamaoto.2016.2018
Text Size: A A A
Published online

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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Change in Grade of Stenosis Before and After Spray Cryotherapy (SCT)

Post-SCT grade was obtained at the last available outpatient follow-up (range, 1-26 months).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Bronchoscopic Evaluation of Airway Caliber Before and After Spray Cryotherapy (SCT) Application
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Individual Patient Treatment Timeline for All Patients Who Underwent Application of Endoluminal Spray Cryotherapy (SCT)

The timeline starts at first treatment and ends at last follow-up. Each symbol represents a procedure.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Video.

Spray Cryotherapy Application

Video demonstrates application of spray cryotherapy followed by balloon dilatation in a woman in her 50s who developed posttracheotomy tracheal stenosis.

Some tools below are only available to our subscribers or users with an online account.

127 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Multimedia
Articles Related By Topic
Related Collections
PubMed Articles
Treatment of Benign Tracheal Stenosis Using Endoluminal Spray Cryotherapy. JAMA Otolaryngol Head Neck Surg Published online Aug 11, 2016;
Jobs
brightcove.createExperiences();