Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, U.S.A.
Cleveland Clinic Voice Center, Cleveland, Ohio, U.S.A.
Laryngoscope. 2024 Jul;134(7):3260-3266. doi: 10.1002/lary.31393. Epub 2024 Mar 19.
A small number of Idiopathic subglottic stenosis (iSGS) patients are treated at institutions across the country. Divergence in operative techniques for endoscopic dilation (ED) of iSGS has been anecdotally recognized but not formally characterized. Additionally, the relationship between procedural variation and clinical outcome has not been studied.
Secondary analysis of the NoAAC iSGS cohort investigated variation in procedural techniques and treatment outcomes in patients treated with ED across high-enrolling treatment centers (enrolled >10 patients in PR-02 trial).
Thirteen NoAAC centers each enrolled >10 patients treated with ED for a total of 281 subjects. There was significant variation in procedural details and rate of recurrence among institutions. Hierarchal cluster analysis revealed significant heterogeneity among institutions and clusters in all procedural variables. However, analysis demonstrated a transient delay in disease recurrence in cluster 2 which disappeared with longer longitudinal follow-up. Patient-reported outcome and peak expiratory flow data supported the potential benefit of the technical variation in Cluster 2. Distinct to cluster 2, however, was routine use of adjuvant triple medical therapy (proton pump inhibitor (PPI), antibacterial agent, and steroid inhaler).
Both outcome and procedural technique vary among centers employing ED to treat iSGS. A transient delay in recurrence was observed among centers that routinely prescribed adjuvant medical therapy (antibiotic, inhaled corticosteroid, and PPI) to iSGS patients after endoscopic dilation, which was further supported by patient-reported data and peak expiratory flow data. Prospective studies are needed to understand the effects of adjuvant medical therapy on recurrence after endoscopic dilation.
4 Laryngoscope, 134:3260-3266, 2024.
少数特发性声门下狭窄（iSGS）患者在全国各地的医疗机构接受治疗。经内镜扩张（ED）治疗 iSGS 的手术技术存在差异，这已被认为是不言而喻的，但尚未得到正式描述。此外，手术技术的差异与临床结果之间的关系尚未得到研究。
对 NoAAC iSGS 队列进行二次分析，研究了在高入组治疗中心（PR-02 试验中入组 >10 例患者）接受 ED 治疗的患者中，手术技术和治疗结果的变化。
13 个 NoAAC 中心中，每个中心都有 >10 例患者接受 ED 治疗，总共有 281 例患者。各机构之间的手术细节和复发率存在显著差异。层次聚类分析显示，各机构之间存在显著的异质性，而且在所有手术变量中都存在聚类。然而，分析表明，聚类 2 中疾病复发存在暂时延迟，随着更长时间的纵向随访，这种延迟消失。患者报告的结果和最大呼气流量数据支持了聚类 2 中技术变化的潜在益处。然而，与聚类 2 不同的是，常规使用辅助三联药物治疗（质子泵抑制剂（PPI）、抗菌剂和皮质类固醇吸入剂）。
采用 ED 治疗 iSGS 的中心之间，治疗结果和手术技术均存在差异。在常规为接受 ED 治疗的 iSGS 患者开具辅助药物治疗（抗生素、吸入皮质类固醇和 PPI）的中心中，观察到复发的暂时延迟，这进一步得到了患者报告数据和最大呼气流量数据的支持。需要进行前瞻性研究，以了解辅助药物治疗对 ED 后复发的影响。
4 Laryngoscope，134：3260-3266，2024。
