Office-Based Lower Airway Endoscopy: Feasibility and Safety

Area of Science:

• Pediatric Pulmonology
• Otolaryngology
• Flexible Endoscopy

Background:

• Office-based lower airway endoscopy (OLAE) is an emerging procedure for evaluating pediatric airway conditions.
• Assessing the ease and safety of OLAE in patients with and without comorbidities is crucial for its widespread adoption.

Purpose of the Study:

• To determine the ease and safety of office-based lower airway endoscopy (OLAE).
• To identify common indications and diagnoses associated with OLAE.
• To evaluate OLAE in pediatric patients with and without comorbidities.

Main Methods:

• Retrospective review of 706 in-office flexible fiberoptic procedures in 567 patients.
• Utilized a grading system to assess visualization of the subglottis, trachea, and carina.
• Analyzed 488 videos, with 105 OLAE procedures included for detailed review.

Main Results:

• Laryngomalacia was the most frequent diagnosis (36%) in OLAE procedures.
• Tracheal visualization showed statistical significance between different types of laryngomalacia (P=.035).
• No complications were identified in any of the OLAE procedures, including those with comorbidities.

Conclusions:

• Office-based lower airway endoscopy (OLAE) is a safe alternative to operative laryngoscopy in pediatric patients.
• OLAE may be more challenging than previously reported, particularly in combined laryngomalacia types.
• The procedure appears safe for patients with comorbidities when appropriate precautions are implemented.