Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease – a prospective, randomized, multicentre cross-over trial

Abstract

Background Bronchoscopic cryobiopsy is a new method of bronchoscopic tissue sampling in interstitial lung disease. In case of transbronchial biopsies, the resultant tissue samples are of high quality, and the lung parenchyma seen in the samples is adequate for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most important procedure- associated complication and may be life threatening. This study addresses the risk of bleeding of transbronchial cryobiopsy. Methods In this prospective, randomized, controlled multicentre study 359 patients with interstitial lung disease requiring diagnostic bronchoscopic tissue sampling were included. Both conventional transbronchial forceps biopsy and transbronchial cryobiopsy were undertaken in each patient. The sequence of the procedures was randomized. Bleeding severity was evaluated semi-quantitatively as “no bleeding”, “mild” (suction alone), “moderate” (additional intervention) or “severe” (prolonged monitoring necessary or fatal outcome), for each intervention. Results In 359 patients atotal of 1160 cryobiopsies and 1302 forceps biopsies were performed. Bleeding was observed after forceps biopsy in 173 patients (48.2%) and after cryobiopsy in 261 patients (72.7%). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 27.3%/51.8%; mild 56.5%/44.0%; moderate 15.0%/4.2%; severe 1.2%/0%; p < 0.001). The rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures compared to the forceps biopsies (16.2% vs. 4.2%, p < 0.05). No fatal bleeding complications occurred. Conclusions Compared to transbronchial forceps biopsy, transbronchial cryobiopsy was associated with an increased risk of bleeding which is of clinical relevance. Therefore training and additional precautions for bleeding control should be considered. Trial registration The study was registered with clinicaltrials.gov ( NCT01894113 ).

Diagnosis of Hypersensitivity Pneumonitis in Adults: An Official ATS/JRS/ALAT Clinical Practice Guideline

“…A systematic search of the literature identified 695 potentially relevant articles. The full text of 34 articles was reviewed, and 24 observational studies were selected to inform the guideline committee ( 257 , 261 , 262 , 264 , 268 – 287 ). One study enrolled patients with known or suspected HP, 19 enrolled patients with ILD, and 4 enrolled patients with DLD.…”

Diagnostic yield, safety, and impact of transbronchial lung biopsy in mechanically ventilated, critically ill patients: a retrospective study

“…In addition, the subgroup of ventilated lung transplant recipients probably experience an even lower pneumothorax risk due to pre-existing pleural adhesions [ 9 ]. No serious bleeding events occurred, which previously have been reported in up to 5% for transbronchial forceps biopsy [ 19 ]. The low AE rate in the present study may be at least in part attributed to the experience of the bronchoscopists, probably preventing the broad applicability of this technique in the ICU.…”

Diagnostic Yield, Safety and Impact of Transbronchial Lung Biopsy in Mechanically Ventilated Critically Ill Patients: A Retrospective Study

“…In addition, the subgroup of ventilated lung transplant recipients probably experience an even lower pneumothorax risk due to pre-existing pleural adhesions [9]. No serious bleeding events occurred, which previously have been reported in up to 5% for transbronchial forceps biopsy [19]. In summary, the more favorable risk pro le of the TBLB compared to the SLB must be weighed against its lower diagnostic yield, leading to a higher probability of misclassi cation of a disease, which can be fatal in the case of respiratory failure with mechanical ventilation, since an incorrect treatment is ineffective or may be even harmful.…”