Endoscopic Treatment of Idiopathic Subglottic Stenosis: A Systematic Review

To identify different endoscopic techniques for treatment of idiopathic subglottic stenosis (iSGS) and evaluate treatment results. Embase and Cochrane Library were searched for publications on endoscopically treated iSGS. Identified interventions included procedures with cold knife, dilation (rigid or balloon), or laser (CO or Nd:YAG), used in several combinations and supplemented with mitomycin C and/or corticosteroids. Primary endpoint was time interval between successive endoscopic procedures. Secondary endpoints were stenosis recurrence rate, total number of interventions per patient during follow-up, tracheotomy rate, and rate of open surgery. Eighty-six abstracts were reviewed and 15 series were included in the analysis. Mean sample size was 57 subjects (range 10-384, σ 90.84) and mean age was 47 years (range 36-54, σ 4.45). Time interval ranged from 2 to 21 months [weighted mean (WM): 12]. Rate of stenosis recurrence ranged from 40 to 100% (WM: 68%). Mean amount of interventions per patient varied between 1.8 and 8.3 (WM: 3.7). Tracheotomy rate varied between 0 and 26% (WM: 7%) and rate of open surgery varied between 0 and 27% (WM: 10%). Single modality CO lasering showed highest rate of recurrence, highest amount of interventions, and shortest time interval. Combined techniques generated overall better outcomes. A multitude of endoscopic techniques are being used for treating iSGS, all with a considerable recurrence rate. In this review, no superior modality could be identified. Consequently, endoscopic management could be considered a valuable primary treatment option for iSGS, but open surgery still plays an important role.