Utilizing an Endobronchial Blocker and a Flexible Bronchoscope for Transbronchial Cryobiopsies in Diffuse Parenchymal Lung Disease

Hohberger, Laurie A.; DePew, Zachary S.; Utz, James P.; Edell, Eric S.; Maldonado, Fabien

doi:10.1159/000368616

Cited by 17 publications

(15 citation statements)

References 6 publications

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“…No mortality and no hemodyanamic instability were reported because of bleeding. Iced cold saline, diluted vasoconstrictive agents, electrocoagulation, endobronchial blocker and fogarty balloon should be available in a centre undergoing CB as a diagnostic tool, as these can aid in controlling bleeding. A secure airway using endotracheal tube, rigid bronchoscope, laryngeal airway mask or igel airway can be used to re‐insert the bronchoscope more easily to suction and control any bleeding.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta‐analysis

et al. 2016

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Forceps biopsy (FB) is the most commonly used diagnostic tool for lung pathologies. FB is associated with a high diagnostic failure rate. Cryobiopsy (CB) is a novel technique providing a larger specimen size, few artefacts, more alveolar parts and superior diagnostic yield. CB, however, has drawbacks such as higher bleeding and pneumothorax rate. We conducted a metaanalysis to investigate the specimen area, diagnostic rate and bleeding severity in CB versus FB in interstitial lung diseases (ILDs) and lung tumours. A systematic literature search of PUBMED, BIOSIS PRE-VIEW and OVID databases was conducted using specific search terms. Eligible studies including RCTs and nonRCTs comparing cryobiopsy/cryotransbronchial biopsy (CB/CTBB) and forceps biopsy/forceps transbronchial biopsy (FB/FTBB) for specimen area, diagnostic rate and bleeding rate in ILDs and lung tumours were analysed. Two reviewers independently extracted data and evaluated the quality of the studies. Eight studies involving 916 patients were analysed. Specimen area (mm 2 ) was significantly larger in CB/CTBB than FB/FTBB (standard mean difference = 1.21, 95% confidence interval (0.94, 1.48), P < 0.00001). The diagnostic rate was significantly higher in CB/CTBB than FB/FTBB (Risk ratio 1.36, 95% confidence interval (1.16, 1.59), P = 0.0002). Three studies compared the bleeding severity with only one showing significantly more bleeding in CB. Cryobiopsy/cryotransbronchial shows superiority to FB/FTBB for specimen area and diagnostic rate. CB/CTBB has better efficacy over FB/FTBB.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta‐analysis

et al. 2016

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“…Routine bronchial blocker use was initially reported by authors utilizing rigid bronchoscopy (25,33). Subsequently, a technique allowing placement of an endobronchial blocker external to an endotracheal tube was described, such that the blocker does not encumber the bronchoscope moving in or out of the endotracheal tube (67). Blockers have also been used with laryngeal mask airways (68).…”

Section: Bleeding Preparedness and Managementmentioning

confidence: 99%

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

Lentz¹,

Argento²,

et al. 2017

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Transbronchial lung biopsy with a cryoprobe, or cryobiopsy, is a promising new bronchoscopic biopsy technique capable of obtaining larger and better-preserved samples than previously possible using traditional biopsy forceps. Over two dozen case series and several small randomized trials are now available describing experiences with this technique, largely for the diagnosis of diffuse parenchymal lung disease (DPLD), in which the reported diagnostic yield is typically 70% to 80%. Cryobiopsy technique varies widely between centers and this predominantly single center-based retrospective literature heterogeneously defines diagnostic yield and complications, limiting the degree to which this technique can be compared between centers or to surgical lung biopsy (SLB). This review explores the broad range of cryobiopsy techniques currently in use, their rationale, the current state of the literature, and suggestions for the direction of future study into this promising but unproven procedure.

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“…Patients were fiberoptically intubated with a size 8, cuffed endotracheal tube with an Arndt bronchial blocker (Cook, Bloomington, Indiana) positioned deflated in the mainstem on the side chosen for biopsies as previously described. 19 All anticoagulants were discontinued before the procedure as recently recommended. 20 The bronchoscope (Olympus XT180, Olympus America Inc, Center Valley, Pennsylvania) was then advanced to the segment chosen for biopsies, typically the anterior and lateral segments of the lower lobes.…”

Section: Cryobiopsiesmentioning

confidence: 99%

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

Roden¹,

Kern

Aubry³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Transbronchial cryobiopsy technique yields larger biopsies with enhanced quality. The benefits and safety of cryobiopsies have not been thoroughly studied in lung allografts.Objective.-To compare size, quality, reproducibility of interpretation of rejection and complications of cryobiopsies with those of conventional biopsies from lung allografts.Design.-All cryobiopsies (March 2014-January 2015) of lung allografts performed at Mayo Clinic, Rochester, and medical records were reviewed. For comparison, conventional biopsies from the same patient or, if unavailable, from a random patient, were selected. Two pathologists blinded to outcome reviewed all biopsies. Specimen volume, number of alveoli, small airways, and pulmonary vessels were counted and statistically compared.Results.-Fifty-four biopsies (27 cryobiopsies) from 18 patients (11 men) were reviewed. A median of 3 (range, 2-5) and 10 (range, 6-12) specimens were obtained with cryobiopsies and conventional biopsies, respectively. Cryobiopsies were larger and contained more alveoli (P , .001, both) and small airways (P ¼ .04). Conventional biopsies showed more fresh alveolar hemorrhage (procedural) and crush artifact/atelectasis (P , .001, both). Cryobiopsies contained more pulmonary veins and venules (P , .001). There was no significant difference between the types of biopsies with respect to the reviewers' agreement on grades of rejection. Complications were more frequent in the cryobiopsy group, though the difference was not statistically significant.Conclusions.-Cryobiopsies of lung allografts are larger and have less artifact. However, complications occur and should be considered. Three cryobiopsy specimens appear sufficient for histopathologic evaluation of lung allografts.

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Utilizing an Endobronchial Blocker and a Flexible Bronchoscope for Transbronchial Cryobiopsies in Diffuse Parenchymal Lung Disease

Cited by 17 publications

References 6 publications

Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta‐analysis

Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta‐analysis

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

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