Efficacy of Multimodal Bronchoscopic Interventions for Benign Central Airway Stenosis and Prognostic Factors: A Retrospective Cohort Study

Chengjin LI; Rongrong WU; Guiping LIU; Jiefu TANG; Le WANG; Zhuang LUO

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Chengjin LI, Rongrong WU, Guiping LIU, Jiefu TANG, Le WANG, Zhuang LUO. Efficacy of Multimodal Bronchoscopic Interventions for Benign Central Airway Stenosis and Prognostic Factors: A Retrospective Cohort Study[J]. Journal of Kunming Medical University.

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Efficacy of Multimodal Bronchoscopic Interventions for Benign Central Airway Stenosis and Prognostic Factors: A Retrospective Cohort Study

1.
Department of Respiratory and Critical Care Medicine I，The First Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032
2.
The Department of Radiology，The First People's Hospital of Yunnan Province，Kunming Yunnan 650032
3.
Department of Respiratory and Critical Care Medicine，Yunnan Diannan Central Hospital （The First People's Hospital of Honghe Prefecture），Honghe Yunnan 661100，China

Received Date: 2025-06-16
Available Online: 2025-12-19

Abstract

Abstract

Objective To compare the clinical efficacy of three bronchoscopic interventional regimens for benign central airway stenosis （BCAS） and identify prognostic factors, so as to provide evidence-based support for individualized treatment. Methods A total of 101 BCAS patients who underwent bronchoscopic interventional therapy at the Respiratory Endoscopy Center of The First Affiliated Hospital of Kunming Medical University from January 2022 to December 2024 were retrospectively enrolled. They were divided into three groups according to the treatment regimen: Group A （Nd:YAG laser + balloon dilation, n = 31）, Group B （Nd:YAG laser + balloon dilation + triamcinolone acetonide, n = 33）, and Group C （Nd:YAG laser + balloon dilation + triamcinolone acetonide + cryotherapy, n = 37）. The primary endpoints included treatment effective rate, restenosis-related indicators （incidence and median time）, quality of life, and complication rate. Statistical analyses were performed using SPSS 26.0 and GraphPad Prism 9.0. Results At 2 months after surgery, the stenosis grade in Group C （3.05±0.70） was significantly superior to that in Groups A and B （P = 0.002）, with a more obvious decrease in white blood cell count. During the 12-month follow-up, the total effective rate of Group C reached 86.49%, which was significantly higher than that of Group A （67.74%） and Group B （69.70%）（P < 0.05）. The median time to first restenosis in Group C （4.7 months） was 47.5% longer than that in Group A （3.2 months） and Group B （3.5 months）（P = 0.020）. Both the improvement rate of forced expiratory volume in 1 second （FEV1）（27.8%） and the Karnofsky score at the last follow-up （82.7 points） in Group C were significantly higher than those in the other two groups （P < 0.01）. In terms of safety, there was no significant difference in the incidence of bleeding among the three groups, but the incidence of hypoxemia in Group B was relatively higher （21.2%）. Subgroup analysis showed that the treatment effective rate of Group C in patients with post-intubation stenosis （90.00%） was significantly higher than that in Group A （63.64%） and Group B （72.73%）（P = 0.045）, while the advantage in patients with tuberculous stenosis did not reach statistical significance （P = 0.089）. Multivariate Logistic regression analysis revealed that the treatment regimen was an independent prognostic factor for BCAS patients （OR = 3.258, 95%CI: 1.563-6.794, P = 0.002）. Conclusion The quadrature therapy regimen integrating Nd:YAG laser ablation, balloon dilation, intralesional triamcinolone acetonide injection, and cryotherapy demonstrates superior clinical efficacy in the management of benign central airway stenosis （BCAS）. This multimodal approach significantly enhances the therapeutic response rate and markedly prolongs the restenosis-free interval.
- Benign central airway stenosis,
- Interventional pulmonology,
- Multimodal therapy,
- Restenosis,
- Prognostic factors,
- Retrospective study

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References(38)

References

[1]	中华医学会呼吸病学分会. 良性气道狭窄介入诊治共识. 2017. 中华结核和呼吸杂志, 2017, 40(06): 408-418.
[2]	许承非, 陈逸霖, 石荟, 等. 良性气道狭窄的分子机制研究进展[J]. 中国呼吸与危重监护杂志, 2024, 23(4): 300-304.
[3]	Wahidi M M, Lamb C, Murgu S, et al. American Association for Bronchology and Interventional Pulmonology (AABIP) Guidelines for the Management of Benign Central Airway Stenosis[J]. Chest, 2024, 165(3): e67-e99.
[4]	王德宠, 李金泉, 何元兵. 良性中央型气道狭窄介入治疗的现状与研究进展[J]. 江苏医药, 2024, 50(01): 94-97. doi: 10.19460/j.cnki.0253-3685.2024.01.021
[5]	Patel A J, Budacan A M, Kumar S, et al. Management of benign airway stenosis- predictors of tracheal resection[J]. J Thorac Dis, 2024, 16(11): 7640-7650. doi: 10.21037/jtd-24-727
[6]	Fiorelli A, Pecoraro A, Failla G, et al. Endoscopic management of benign airway stenosis in coronavirus disease 2019 patients[J]. Thorac Cardiovasc Surg, 2024, 72(4): 320-325. doi: 10.1055/a-2075-8109
[7]	Ye Y S, Chen D F, Liu M, et al. Autologous airway basal cell transplantation alleviates airway epithelium defect in recurrent benign tracheal stenosis[J]. Stem Cells Transl Med, 2023, 12(12): 838-848. doi: 10.1093/stcltm/szad062
[8]	Wei J, Qin S, Li W, et al. Analysis of clinical characteristics of 617 patients with benign airway stenosis[J]. Front Med, 2023, 10: 1202309. doi: 10.3389/fmed.2023.1202309
[9]	Ravikumar N, Ho E, Wagh A, et al. The role of bronchoscopy in the multidisciplinary approach to benign tracheal stenosis[J]. J Thorac Dis, 2023, 15(7): 3998-4015. doi: 10.21037/jtd-22-1734
[10]	郑梦梦, 卢立锦, 周知, 等. 1 例良性气道狭窄病人行气管硬镜下硅酮支架植入术的护理[J]. 循证护理, 2024, 10(12): 2278-2280.
[11]	苏江, 翁涛平, 张先明. 硅酮支架治疗三种常见良性中心气道狭窄的对照研究 [J]. 中国呼吸与危重监护杂志, 2024, 23 (4): 231-236.
[12]	Ratwani A P, Lentz R J, Chen H, et al. Spray cryotherapy for benign large airway stenosis: A multicenter retrospective cohort study of safety and practice patterns[J]. J Bronchol Interv Pulmonol, 2024, 31(1): 63-69. doi: 10.1097/LBR.0000000000000930
[13]	Rusakov M A, Parshin V D, Simonova M S, et al. Airway stenting in patients with complex benign tracheobronchial stenosis[J]. Khirurgiia (Mosk), 2022(11): 5-12.
[14]	Fiorelli A, Messina G, Bove M, et al. Ultrasound for assessment and follow-up of airway stenosis[J]. Ann Thorac Surg, 2022, 113(5): 1624-1633. doi: 10.1016/j.athoracsur.2021.05.056
[15]	Wei J, Chen Y, Feng T, et al. miR-34c-5p inhibited fibroblast proliferation, differentiation and epithelial-mesenchymal transition in benign airway stenosis via MDMX/p53 pathway[J]. Funct Integr Genom, 2024, 24(2): 37. doi: 10.1007/s10142-024-01317-y
[16]	Cheng Z, Chen Z, Yang S, et al. Comparison of clinical efficacy of different bronchoscopic interventions in benign airway stenosis: a systematic review and network meta-analysis. Journal of Thoracic Disease, 2021, 13(11): 6411-6423.
[17]	Bertino G, Pedretti F, Mauramati S, et al. Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study[J]. Acta Otorhinolaryngol Ital., 2023, 43(Suppl 1): S111-S122.
[18]	Wang R, Cheng J, Zhang Y, et al. Analysis of risk factors for benign central airway stenosis after COVID-19 infection[J]. Eur J Med Res, 2024, 29(1): 624. doi: 10.1186/s40001-024-02216-5
[19]	Ratwani A P, Lentz R J, Chen H, et al. Spray Cryotherapy for Benign Large Airway Stenosis: A Multicenter Retrospective Cohort Study of Safety and Practice Patterns[J]. J Bronchology Interv Pulmonol, 2024, 31(1): 63-69.
[20]	He J, Yu M, Li X, et al. Local Triamcinolone Acetonide Injection Combined with Conventional Interventional Methods in the Treatment of Benign Central Airway Stenosis: A Meta-analysis of Efficacy and Safety[J]. Journal of Thoracic Disease, 2021, 20(10): 726-733.
[21]	Lei X, Meng Y, Wang X, et al. The Role of Local Steroid Therapy in the Management of Benign Airway Stenosis: A Systematic Review and Meta-analysis[J]. Respiratory Research, 2021, 22(1): 282. doi: 10.1186/s12931-021-01879-6
[22]	Emam W, Mostafa Y, Madkour A, Elgazzar T, Shehata M, Elbadrawy R, et al. Bronchoscopic management as an alternative treatment in non-operable benign tracheal stenosis. Int J Clin Pract. 2021;75(5): e14058.
[23]	Natale G, Reginelli A, Testa D, et al. The use of 3D printing model as tool for planning endoscopic treatment of benign airway stenosis[J]. Transl Cancer Res TCR, 2020, 9(3): 2117-2122. doi: 10.21037/tcr.2020.01.22
[24]	GOLD Science Committee. Global Strategy for the Prevention, Diagnosis and Management of Chronic Obstructive Pulmonary Disease: 2025 Report - Executive Summary[J]. Am J Respir Crit Care Med, 2025, 211: 1-20.
[25]	Howdon D, van den Hout W, van der Linden Y, et al. Replacing performance status with a simple patient-reported outcome in palliative radiotherapy prognostic modelling[J]. Clin Transl Radiat Oncol, 2022, 37: 137-144. doi: 10.1002/1097-0142(19800415)45:8<2220::AID-CNCR2820450835>3.0.CO;2-Q
[26]	Mehta V, Gerchman L, Hacht JL, et al. Balloon bronchoplasty for benign airway strictures: systematic review and meta-analysis. Eur Respir J. 2023;61(2): 2201237.
[27]	Batra H, Yarmus L. Indications and complications of rigid bronchoscopy[J]. Expert Rev Respir Med, 2018, 12(6): 509-520. doi: 10.1080/17476348.2018.1473037
[28]	Fiorelli A, Messina G, Santoriello C, et al. Endobronchial ultrasound for benign tracheal stenosis[J]. Thorac Cardiovasc Surg, 2019, 67(3): 232-234. doi: 10.1055/s-0038-1668597
[29]	Bilaçeroğlu S, Aydoğdu Z, Takiguchi Y. Updates in Interventional Bronchoscopy for Benign Central Airway Obstruction[J]. Journal of Clinical Medicine, 2021, 10(17): 3940. doi: 10.3390/jcm10173940
[30]	Verret D J, Chakraborty R K, Bailey L S, et al. Advanced Laser Techniques for Endoscopic Treatment of Benign Tracheal Stenosis: Long - Term Outcomes[J]. Otolaryngology - Head and Neck Surgery, 2022, 166(4): 762-769.
[31]	Russo E, Guarino E, Lopez C, et al. Benign airway stenosis: modern technological interventions. ERJ Open Res. 2022;8(4)00651-2022.
[32]	Oh D K, Kim S H, Koo H K, et al. Airway remodeling differences in post-tuberculosis and post-intubation tracheal stenosis: a prospective observational study. Scientific Reports, 2022, 12(1): 13546.
[33]	Akulian J A, Yarmus L, Wahidi M M, et al. Interventional Pulmonology: An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline. Chest. 2022;162(6): e363-e381.
[34]	Murgu S D, Colt H G. Airway Stenosis: Functional Classification and Interventional Bronchoscopy[J]. Eur Respir J, 2021, 58: 2100756.
[35]	Marwah V, Bhardwaj B, Vadlamudi KV, et al. Holistic approach to management of benign tracheobronchial stenosis: A retrospective single-center experience. Lung India, 2022, 39(3): 226-231.
[36]	Dutau H, Breen D P, Gomez C, et al. The integrated therapeutic bronchoscopy management of benign complex tracheobronchial stenosis: A pooled analysis. Respiratory Medicine, 2021, 176: 106280.
[37]	Kenn K, Foerster M, Hupertz S, et al. Clinical outcomes and follow-up approach in patients treated with multimodal bronchoscopic intervention for benign airway stenosis. Therapeutic Advances in Respiratory Disease, 2022, 16: 17534666221112403.
[38]	Qiu X, Liu Y, Zhang J, et al. Paclitaxel-loaded PLGA coating stents in the treatment of benign cicatricial airway stenosis[J]. J Clin Med, 2022, 11(3): 517. doi: 10.3390/jcm11030517

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