A multi-centre retrospective review of the bronchoscopic management of upper tracheal stenosis: an Australian perspective

Background: Upper tracheal stenosis (UTS) is a rare process with multiple causes and variable approaches to treatment. Australian data on management patterns are lacking and patient resources reflecting local practices are scarce. Aims: To describe the management strategies of UTS over 12 years among three teaching hospitals in New South Wales, Australia. A secondary aim is to formulate an evidence-based patient information sheet for this condition and its management. Methods: Retrospective descriptive case series. Demographic, procedural and spirometric data were obtained from the medical records of patients undergoing bronchoscopy for UTS between March 2012 and February 2024. Results: A total of 31 patients (81% female) underwent 120 procedures (median: 3; interquartile range: 1–5) with a median procedure interval of 134 days. The interventions included 82 balloon dilatations, 37 steroid injections, 54 radial incisions (28 endoscopic scissors, 26 laser) and seven stent insertions. Following serial procedures, there were improvements in mean maximum forced expiratory flow (FEF_max) by 1.62 L/s (95% CI: 1.05–2.15, P < 0.001) and FEF_max percent predicted by 27% (95% CI: 18–36, P < 0.001). The mean FEV₁ improved by 0.36 L (95% CI: 0.15–0.54, P = 0.002) and 14% predicted. There was a documented improvement in symptoms in 80% of therapeutic procedures. Complications were infrequent and higher in procedures involving stents. Based on these findings, a patient information sheet has been developed. Conclusions: Patients with UTS undergo several bronchoscopies that result in improvements in symptoms and function with relatively low rates of complications.