The role of bronchoscopy in benign airway stenosis: literature review of a central procedure guiding multidisciplinary care and therapeutic approach for improving patient outcomes.

Background and Objective: Tracheal stenosis is a potentially life-threatening condition whose symptoms including dyspnea, wheezing and cough, are frequently misdiagnosed, leading to a delay in the diagnosis. The more frequent causes of stenosis are iatrogenic: prolonged intubation (producing a circumferential ischemic injury of the mucosa and consequent scarring) and tracheotomy (due to a direct damage of tracheal wall). However, other causes include autoimmune disease, infections, previous radiation therapy. This review aims to highlight the role of bronchoscopy, not only as a diagnostic procedure, but also as a therapeutic option in selected patients. Methods: Herein, we will briefly summarize the most recent data available on bronchoscopy for tracheal stenosis, focusing on its role in the diagnosis and as a treatment option, evaluating advantages, disadvantages and controversies of different techniques. This review was based on searches in PubMed (MEDLINE) and Google Scholar database, by using the following keywords: "benign tracheal stenosis", "benign airway stenosis", "rigid bronchoscopy", "mechanical dilatation", "laser application", "drugs submucosal application" and "tracheal stent". Key Content and Findings: Bronchoscopy represents a mandatory diagnostic procedure: it offers essential information with regard to the status of the mucosa, the site, the length, the severity and the morphology of the stricture, the distance between the stenosis and the vocal cord and the carina. Along with the imaging [neck and chest computed tomography (CT) scan] that can show possible cartilage damage and the status of the tissue surrounding the trachea, bronchoscopy is fundamental for choosing the appropriate therapeutic approach and its timing. Additionally, interventional bronchoscopy, such as laser assisted mechanical dilatation, airway stenting and pharmacological intralesional treatments, represents a valid therapeutic option in selected patients. Conclusions: Herewith, we summarize the data of literature, highlighting the role of bronchoscopy, not only as a diagnostic procedure, but also as a therapeutic option in selected patients. We hope this review will help other physicians in evaluating patients with tracheal stenosis and in choosing the appropriate treatment strategy. Additionally, we would promote other clinicians to report their own data on bronchoscopy, as a essential moment for diagnosis and as therapeutic treatment.