[Endoluminal therapy of the trachea and bronchus]

The application of endoscopic techniques is common in the treatment of tracheal and bronchial diseases today. Bronchoscopic interventions are used in both elective and emergency situations. Laser therapy for malignant tumors is purely palliative in most cases and should only be performed in nonsurgical patients. However, 30% of lung cancers cause obstruction in the trachea and main bronchi. Benign tumors and tracheal stenoses could require laser recanalization or the implantation of stents, if surgery will be the second step or will not be possible. In patients with foreign body aspiration, massive hemoptysis, or severe obstruction of the trachea, emergency bronchoscopy is necessary. A more recent type of bronchoscopic intervention is the treatment of bronchial stump or anastomosis insufficiency as well as minimal iatrogenic injuries using spongiotic fillings or stent implantation. The use of therapeutic bronchoscopy requires great experience in rigid and flexible bronchoscopy, the possibility of high-frequency jet ventilation as well as laser and argon application, and the possibility to implant different types of stents. More advanced bronchoscopic interventions should only be done if a department of thoracic surgery exists, in view of the potential need to control complications or perform further treatment. Especially the bronchoscopic treatment of tracheal stenosis should be performed by the thoracic surgeon himself or in close contact with a thoracic surgeon who is experienced in tracheal resections.