OPA16 CHALLENGES AND CONTROVERSIES IN THE TREATMENT OF ENDOBRONCHIAL TUBERCULOSIS WITH CENTRAL AIRWAY OBSTRUCTION

Yen Shen Wong1, Chen Yong Tan2, Sumithra appava2, Fatimah Zaharah Rosli2, Chang Zhao Nao2, Khavisha Vijaya Kumar2, Muhammad Halmii Faisal Thena2, Nor Afiqah Mohd Sebri2, Jamalul Azizi Abdul Rahaman2, Mona Zaria Nasaruddin2,
1Faculty Of Medicine, Universiti Teknologi Mara (UiTM) Sg Buloh, Selangor, Malaysia
2Pulmonology Department, Sultan Idris Shah Serdang Hospital, Selangor, Malaysia

Introduction:

Balloon dilatation is the mainstay of treatment for endobronchial tuberculosis with central airway obstruction (CAO), but recurrent stenosis remains a significant challenge. The roles of prolonged anti-TB therapy, repeated mitomycin C, and early stent insertion in preventing stenosis remains controversial. 

Objectives:

This study aims to describe the demographic and clinical outcomes various treatment modalities for tuberculosis patients with CAO. 

Methodology:

A 7-year retrospective analysis was conducted on patients with pulmonary tuberculosis and CAO at Hospital Serdang, Malaysia. 

Results:

The study analysed 51 patients with 147 therapeutic rigid bronchoscopies. Most patients were female (84.3%) with a mean age of 33.1 ± 14.7 years. Balloon dilatation was used in 86.3% of cases, followed by mitomycin (68.7%), stent insertion (17.6%), and cryotherapy (3.9%). Mitomycin use reported no complications, but tears during dilatation occurred in 11.8% of patients. Airway stent-related complications included granuloma formation (55.8%), migration (22.2%), and stent blockage (33.3%). 

Recurrence of stenosis was observed in 45.1% of patients, with a mean duration of 37.6 months. Complex tracheal stenosis and malacic airway were significantly associated with higher incidences of recurrent stenosis (P=0.041 and P=0.01, respectively). Prolonged anti-TB duration and repeated mitomycin use were not associated with the prevention of recurrent stenosis (P=0.245 and P=0.803, respectively).

Conclusion:

Prolonged anti-TB therapy and repeated mitomycin use did not prevent recurrent airway stenosis. In patients with malacic airways, early tracheal stenting appears to be more effective in stabilizing airway patency.