Management & Follow-up of SGS-GPA
All 21 patients underwent IS on SGS diagnosis; four (19%) required
solely medical therapy, with the majority requiring surgical dilatation
(81%). Figure 1 displays the individual management pathways of the
cohort.
Following dilatation and induction IS all patients remained on
maintenance oral IS. Eighteen patients (90%) went into remission, with
no further active inflammation reported. Two patients experienced
relapse with recurrent SGS during their follow-up period requiring
further IS (figure 1 – patients 9 &19).
A total of twenty-nine SGS dilatations (24 bougie & 5 balloon
dilatations) were performed. Four of the patients required emergency
tracheostomy (patient 9 required a tracheostomy on two separate
occasions). All patients were successfully decannulated.
Intralesional steroid (40mg methylprednisolone) was utilised in the four
balloon dilatations, with intravenous corticosteroid administered in all
procedures. Post-operative complications were experienced following one
balloon dilatation procedure (hospitalisation for pneumonia) and one
tracheostomy (pneumothorax). No complications were recorded for bougie
dilatations.
The cohort (21 patients) was followed up for a mean period of 59.8
months (range 15.7-201.5 months). One patient died from urosepsis
(unrelated to GPA progression).
When calculating the mean PFI; 17 patients underwent 34 procedures were
followed up for an average of 66.5 months. The mean PFI was denoted to
be a procedure every 31.3 months (range of 5.4- 201.5 months). Figure 2
represents the regression model attained (72% concordance). None of the
covariables reviewed showed any statistically significant impact on PFI.