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.