Endoscopic management of pediatric subglottic stenosis: Impact of a frequent dilation regimen at a referral center in Colombia.

INTRODUCTION AND

OBJECTIVE

Pediatric subglottic stenosis (SGS) is a serious complication of prolonged intubation. There is no consensus on the optimal interval between endoscopic dilatations. This study reports the clinical outcomes of deferred dilation (DD) versus frequent dilation (FD).

MATERIAL AND METHOD: Retrospective cohort study in a tertiary pediatric hospital (2009-2022). We included 190 patients with SGS divided into historical cohorts: DD group (2009-2018, n = 140) and FD group (2019-2022, n = 50). The primary outcome was therapeutic failure, defined as the need for >5 dilatations, tracheostomy, or laryngotracheal reconstruction (LTR).

RESULTS

The median interval between dilatations was 38.5 days (IQR 28-52) in the DD group and 27.5 days (IQR 4-40) in the FD group (p < 0.01). Failure rates were higher in the DD group: >5 dilatations (12.1% vs 0%; p = 0.01), tracheostomy (29.3% vs 22.0%; p = 0.31), and LTR (8.6% vs 4.0%; p = 0.36). Adjuvant use was high and safe (0% adverse events). The use of mitomycin C increased from 75.6% to 89.6% and triamcinolone from 88.3% to 90.9% in the FD group. The need for >5 dilatations was strongly associated with the need for surgery (p = 0.00049).

CONCLUSIONS

The frequent dilation (FD) regimen was associated with a lower need for multiple procedures and a trend towards lower rates of tracheostomy and LTR. The increased use of adjuvants, with a favorable safety profile, suggests a complementary role in improving outcomes.