Efficacy of Endoscopic Interventions for Subglottic Stenosis in Adults: A Systematic Review and Meta-Analysis.

Abstract

Background: Subglottic stenosis (SGS) is a challenging clinical condition with several endoscopic treatments available. This systematic review aims to update the evidence on the efficacy and safety of endoscopic procedures for managing SGS in adult patients.

Methods: Following PRISMA guidelines, we conducted a comprehensive literature search across 4 databases, covering studies from inception to August 2024. We included studies that evaluate different endoscopic interventions for SGS in adult patients. The primary outcome was the success rate of endoscopic procedures, with secondary outcomes including recurrence rate, the need for open surgery, decannulation rate, and procedure-related complications.

Results: Fifty-five studies involving 3091 patients were included. The overall success rate of endoscopic treatments was 72.9%, with CO₂ laser and YAG laser demonstrating success rates of 76.8% and 93.8%, respectively. Balloon dilatation exhibited a success rate of 66.8%. The recurrence rate across all endoscopic interventions was 60.5%, with specific procedures, such as balloon dilatation, showing a higher recurrence rate of 68.4%. The overall rate of requiring open surgery was 7%, and the overall decannulation rate after tracheostomy was 60.1%, with balloon dilation showing the highest rate of successful decannulation among (82.8%). The overall complication rate was 5%.

Conclusion: Endoscopic management of adult subglottic stenosis yields variable success with high recurrence rates. Heterogeneity across studies limits interpretation, and comparative conclusions cannot be drawn. Future studies should standardize outcome definitions, disease severity reporting, and follow-up duration to guide evidence-based practice.