Therapeutic Bronchoscopic Interventions for Non Foreign-Body Removal Indications in Children

Background: The indications for pediatric airway endoscopy are expanding and a variety of therapeutic interventions are feasible for central airway obstruction (CAO) and other central airway pathologies, apart from foreign body removal.

Methods: In this retrospective chart review from four centers, we describe the indications, procedures, outcomes, and complications of therapeutic bronchoscopic interventions in children for non foreign-body removal indications.

Results: A total of 72 children (mean age:140 [60.4] months) underwent 143 therapeutic bronchoscopic airway interventions under general anesthesia, via a rigid or flexible bronchoscope or both, between January 2015 and November 2023. 67 (93%) had CAO. The most common diagnoses were posttubercular tracheobronchial stenosis (29%) followed by central airway tumor (26%) and postintubation/posttracheostomy tracheal stenosis (26%). Airway stenosis (subglottic/tracheal/bronchial) was the commonest bronchoscopic finding (43 [59.7%]) followed by endoluminal growth/mass (21 [29.2%]). The most frequently performed procedure was airway dilatation (38, 52.7%), using balloon dilators (89.5%) or rigid bronchoscope (10.5%). Endoluminal tumor debulking was performed in 21 (29%). Assistive modalities included electrocautery (44%), mechanical debulking (10%), cryotherapy (10%), or laser (4%). Airway stent insertion alone or in combination with airway dilatation or debulking was performed in 24 (33.3%) children. The airway conduit used was supraglottic airway in 19 (26%) and rigid bronchoscope in 53 (74%) children. Immediate procedural success was observed in 66 (92%) patients. Fourteen (19.4%) patients had minor procedural complications. Thirty-three (46%) children required a repeat bronchoscopic procedure.

Conclusion: Like adults, multimodality therapeutic bronchoscopic airway interventions are feasible and safe in children for CAO and other central airway indications.