A Systematic Review and Meta-analysis of Endoscopic Balloon Dilation of Pediatric Subglottic Stenosis

Lang, Michael MD
Brietzke, Scott E. MD, MPH

¹Uniformed Services University, Bethesda, Maryland, USA
²Walter Reed National Military Medical Center, Bethesda, Maryland, USA

Scott E. Brietzke, MD, MPH, Department of Otolaryngology, Walter Reed National Military Medical Center, 8900 Wisconsin Ave, Bethesda, MD 20889, USA. Email: [email protected]

Received June 26, 2013

Received in revised form September 27, 2013

Accepted October 9, 2013

Otolaryngology - Head & Neck Surgery 150(2):p 174-179, February 2014. | DOI: 10.1177/0194599813510867

Objective

Endoscopic balloon dilation (EBD) is an inviting, noninvasive option to manage pediatric subglottic stenosis that could preclude the need for tracheostomy and/or laryngeal-tracheal reconstruction (LTR). However, treatment outcomes and patient selection criteria are not well described.

Data Sources

MEDLINE, EMBASE, and the Cochrane databases were systematically searched using multiple search terms.

Review Methods

A systematic review of pediatric EBD was performed and then reported in compliance with PRISMA principles. Inclusion criteria consisted of a sample size of 5 or greater, pediatric patients, and primary EBD without adjuvant procedures. Meta-analysis was performed with random effects modeling and pooled data regression.

Results

After systematic database search and detailed review, 7 studies were included in the final data set with 150 total subjects. All studies were case series (level 4 evidence). The mean sample size was 20 subjects (range, 5-44), and the grand mean age was 2.2 years (range, 2.2-60 months). The random effects model estimate of the overall treatment success (avoidance of tracheostomy or LTR) was 65.3% (k = 6 studies, 95% confidence interval [CI] = 60.1%-70.6%, P < .001, Q test for heterogeneity = 3.98, P = .552, I² = 0%). Follow-up was inconsistently reported but averaged 4.6 months (range, 0.25-12.5 months). Only 1 study reported significant complications (1 death, 2 tracheal lacerations). Pooled data multivariate regression indicated that increasing Cotton-Meyers grade was associated with decreased odds of success (odds ratio = 0.198, 95% CI = 0.0451-0.870, P = .032). Funnel plot analysis suggested the possibility of publication bias.

Conclusions

EBD is successful in most patients over short-term follow-up. The reported complication rates are low. Increasing severity of subglottic stenosis increases the odds of treatment failure.