Complicaciones post biopsia transbronquial: el papel de la criobiopsia en la incidencia de neumotórax postoperatorio

Abstract

Introducción: La criobiopsia pulmonar transbronquial (TBCB) se ha convertido en una alternativa diagnóstica a la biopsia pulmonar quirúrgica, principalmente en la enfermedad pulmonar intersticial. A pesar de su naturaleza menos invasiva y de un mayor rendimiento diagnóstico, se han descrito algunas complicaciones asociadas, como el neumotórax. En pocas oportunidades se ha comparado la TBCB y la biopsia transbronquial con fórceps (TBFB). El objetivo del presente estudio es evaluar la incidencia de neumotórax después de TBFB y TBCB y la necesidad de drenaje pleural.
 Métodos: Estudio retrospectivo de pacientes que se sometieron a TBCB y TBFB, específicamente aquellos que desarrollaron neumotórax postoperatorio.
 Resultados: Se realizaron un total de 181 biopsias pulmonares transbronquiales. Sesenta y tres (35%) fueron TBFB y 118 (65%) fueron TBCB. Tres pacientes en el grupo TBFB (5%) presentaron neumotórax postoperatorio, mientras que 16 pacientes (14%) presentaron neumotórax en el grupo TBCB (p 0,051). El análisis univariado reveló una asociación estadísticamente significativa entre el diagnóstico preoperatorio de fibrosis y un mayor riesgo de neumotórax postoperatorio después de TBCB (p 0.027), mientras que otras variables no arrojaron un resultado significativo.
 Conclusión: Aunque se necesitan más estudios comparativos de alto volumen, este documento destaca la relevancia del neumotórax después de la TBCB. Esto deriva en una fuerte necesidad de protocolos de procedimientos claramente estandarizados para TBCB y una evaluación cuidadosa de sus complicaciones versus su rendimiento diagnóstico

Flexible bronchoscopy in pediatric lung transplantation

“…81,82 While Transbronchial lung cryobiopsy (TBLC) technique has the potential to improve the quality and size of biopsy samples, TBLC has thus far only been shown to be safe and effective in adult lung transplant recipients, with insufficient properly documented frequency of adverse events in children. When compared to conventional TBB, varying experiences have been reported including an increased risk of bleeding, 7,83 some studies reporting an increased rate of pneumothorax, 84,85 and other reports indicating similar risks for TBLC as the traditional TBB method 86 (Figure 10). biopsy.…”

“…While Transbronchial lung cryobiopsy (TBLC) technique has the potential to improve the quality and size of biopsy samples, TBLC has thus far only been shown to be safe and effective in adult lung transplant recipients, with insufficient properly documented frequency of adverse events in children. When compared to conventional TBB, varying experiences have been reported including an increased risk of bleeding, 7,83 some studies reporting an increased rate of pneumothorax, 84,85 and other reports indicating similar risks for TBLC as the traditional TBB method 86 (Figure 10). Transbronchial needle aspiration (TBNA), endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA), transesophageal bronchoscopy ultrasound‐guided fine needle aspiration (EUS‐B‐FNA), and computerized tomography‐guided fine needle aspiration (CT‐FNA) : These techniques were initially used in adults to diagnose lung malignancies.…”

Safety, utility and clinical efficacy of cryobiopsy of lung in paediatric population—A single centre experience

“…[ 7 , 8 ] When compared to SLB, TBCB has fewer adverse events post-procedure, with shorter hospital stays and high diagnostic yield,[ 9 ] whereas transbronchial biopsy via forceps frequently yields insufficient samples with crush artefacts. Although moderate bleeding and pneumothorax were reported[ 10 ] in adults, there are no reported complications in the paediatric population apart from minor bleeding.…”