Endoscopic balloon dilation for subglottic or tracheal stenosis

Evidence-based recommendations on endoscopic balloon dilation for subglottic or tracheal stenosis. This involves introducing a balloon device with the aim of widening the stenotic airway to improve symptoms.

# Recommendations
Evidence on the safety of endoscopic balloon dilation for subglottic or tracheal stenosis is adequate. The most serious complication related to the procedure, independent of age, is tracheal laceration but this is well recognised.
For babies, children, and young people, evidence on the efficacy of the procedure is adequate to support using it, provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
For adults, evidence on the efficacy of the procedure is limited. So, it should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do endoscopic balloon dilation for subglottic or tracheal stenosis in adults should:
Inform the clinical governance leads in their healthcare organisation.
Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.
Regularly review data on outcomes and safety for this procedure.
This procedure should only be done in specialist centres by clinicians trained in the technique, and with anaesthesia and intensive care support.
Report any problems with a medical device using the Medicines and Healthcare products Regulatory Agency's Yellow Card Scheme.# The condition, current treatments and procedure

# The condition
Subglottic or tracheal stenosis is a narrowing of the airway. It can be congenital, traumatic or, most commonly, iatrogenic after prolonged endotracheal intubation. Symptoms include hoarseness, stridor, exercise intolerance and respiratory distress. In severe cases complete obstruction may happen, needing continued intubation or tracheostomy.

# Current treatments
Treatment options include inhaled or oral steroids to treat inflammation and reduce the severity of stenosis. A cricoid-split operation can decompress the subglottis and prevent development of stenosis in babies. For people with severe and established stenosis, endoscopic techniques such as stent insertion or laser ablation are used. Alternatively, open surgical repair is done to increase the diameter of the stenosed segment with a graft or stent (expansion surgery) or to remove the stenotic area (resection surgery).

# The procedure
The aim of endoscopic balloon dilation is to dilate airway strictures with minimal mucosal trauma by applying pressure to an area of stenosis. The procedure is most commonly done on iatrogenic stenoses, which are typically soft. It is less commonly done on harder, established stenoses.
The procedure is usually done under general anaesthesia, using direct laryngoscopic or bronchoscopic visualisation. A balloon device is introduced into the airway and the balloon is gently inflated, applying radial pressure circumferentially to the stricture. After dilation, the balloon is deflated and the device is withdrawn. The procedure may be used in combination with other treatments. It can be repeated if needed. The aim is to widen the stenotic airway and improve symptoms.