Efficacy of different endoscopic interventions in managing subglottic stenosis in children: a comprehensive systematic review and meta-analysis

OBJECTIVE: To evaluate the effectiveness and safety of endoscopic interventions for managing paediatric subglottic stenosis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane Handbook, we systematically searched four databases from inception to August 2024. Studies reporting outcomes of endoscopic management of paediatric subglottic stenosis were included. The primary outcome was procedural success; secondary outcomes were recurrence, decannulation and complications. RESULTS: Forty-three studies involving 1088 children were included. The pooled success rate of endoscopic treatment was 79.2 per cent. Carbon dioxide and potassium titanyl phosphate laser achieved success rates of 79.9 and 100 per cent, respectively. Balloon dilatation and rigid dilatation had success rates of 79.9 and 82.4 per cent, whereas cold knife alone had a lower rate of 47.2 per cent. The recurrence rate was 36.8 per cent and balloon dilatation showed the highest recurrence at 42.2 per cent. The pooled decannulation rate was 60.4 per cent and complications occurred in 3.0 per cent of cases. CONCLUSION: Endoscopic interventions are effective for paediatric subglottic stenosis, but recurrence remains common.