Unveiling Progress: A Systematic Review and Meta-Analysis of Endoscopic Posterior Cricoid Split With Posterior...

Subglottic and posterior glottic stenosis (PGS) narrows distinct areas of the larynx, while bilateral vocal fold immobility (BVFI) is characterized by static cords. Treatments include open surgeries and newer endoscopic methods, offering comparable safety, quicker recovery, and fewer complications. This study assesses the decannulation rate of endoscopic posterior cricoid split with posterior cartilage grafting (EPCCG) in pediatric patients with posterior glottic stenosis, subglottic stenosis (SGS), and BVFI. Other outcomes include complications, symptom relief, need for additional airway procedures, and hospital stay. We retrieved relevant records published between 2003 and 2024 from PubMed, Scopus, Web of Science, and Cochrane Library. Using OpenMeta v5.26.14 software, we pooled the decannulation rates from individual studies. Other outcomes reported in fewer studies than what justifies a meta-analysis were synthesized manually. The selection process yielded 15 articles, 11 of which were eligible for analysis. The decannulation rate had an estimated proportion of approximately 83.2% (95% CI: 74.0-92.4%). Complications were present in 6/70 patients, and no mortality was reported. Additional airway procedures were needed in 14/82 patients for whom the outcome was reported. Hospital stays averaged 6.1 days in four studies reporting the outcome. Symptomatic relief was achieved in most of the patients; however, some cases reported odynophagia and concerns about voicing. EPCCG shows promise in treating less severe cases of PGS, SGS, and BVFI, offering safety, short hospital stays, and symptomatic relief. However, its efficacy for advanced cases and comorbidities needs more research. The limitations, including multiple pathologies and comorbidities in patients, hinder broader applicability. More extensive studies with standardized protocols are required in order to overcome these limitations.