Cryorecanalization of an Obstructed Bronchial Stent in a 12-Year-Old Boy

Abstract

We report a 12-year-old boy who underwent stent implantation into the left main bronchus at the age of 9.5 years for palliation of severe bronchial stenosis. He had developed complete obstruction of the stent by granulation tissue resulting in respiratory deterioration and the requirement of mechanical ventilation. The stent obstruction was treated at the age of 11.5 years by cryorecanalization. In this technique, cooling of the tip of the cryoprobe is used to induce adherence of the obstructing tissue allowing the subsequent removal of tissue particles by retraction of the probe. Under general anesthesia, a miniaturized cryoprobe was advanced via the working channel of a flexible bronchoscope. Repeat maneuvers of freezing and retraction resulted in complete recanalization of the stent. Repeat bronchoscopies 4 and 12 weeks later revealed recurrent formation of some granulation tissue which was removed by repeat cryorecanalization. Seven months after the initial procedure there was a complete patency of the stent. According to our experience, cryorecanalization is a safe and effective alternative for the treatment of stent obstruction by granulation tissue. Due to the introduction of a miniaturized probe, this method is well applicable in children since it can be performed via the working channel of a flexible pediatric bronchoscope.

New Technologies for C Ryosurgery in Endoscopic Treatment of Lung and Bronchial Tumors

“…Зонд легко извлекается сразу после окончания воздействия низких температур [19]. В отличие от лазерной реканализации с ее высокой энер-гией криореканализацию можно выполнять у пациентов со стентами, не боясь их повреждения, и при высокой концентрации кислорода в дыхательных путях [31]. У всех 7 пациентов после криореканализации отмечалось небольшое кровотечение (до 50-100 мл) из опухоли, которое было остановлено с помощью консервативных методов, включая аргоноплазменную или лазерную коа-гуляцию.…”

Cryoextraction via flexible bronchoscopy in children with tracheobronchial obstruction

“…The success, feasibility, and utility of airway cryotherapy via FB has been reported in children and adults for a variety of indications including endobronchial cryobiopsy, recanalization of obstructed bronchial stents, alleviating airway obstruction due to granulation tissue, mucus plugs, endobronchial tumors, endobronchial thrombi, plastic bronchitis, and removal of aspirated foreign bodies 3,5–13 . However, only a few studies have reported on using cryotherapy via FB in children 3,7,8,10–13 .…”

“…4,5 The success, feasibility, and utility of airway cryotherapy via FB has been reported in children and adults for a variety of indications including endobronchial cryobiopsy, recanalization of obstructed bronchial stents, alleviating airway obstruction due to granulation tissue, mucus plugs, endobronchial tumors, endobronchial thrombi, plastic bronchitis, and removal of aspirated foreign bodies. 3,[5][6][7][8][9][10][11][12][13] However, only a few studies have reported on using cryotherapy via FB in children. 3,7,8,[10][11][12][13] The European Respiratory Society statement on interventional bronchoscopy in children concluded that there are no established indications for cryotherapy in children due to the scarce literature and recommended studies to assess the utility of cryotherapy in children.…”

Cryotherapy in the paediatric airway: Indications, success and safety

“…8 Restoration of airway patency using cryo has been described more frequently in children 9 and for a variety of pathologies, such as plastic bronchitis 10,11 tracheal stenosis, 12,13 and the recanalization of obstructed bronchial stents. 14 Additionally, the removal of bronchial mucoepidermoid carcinoma in six patients 15 and the debulking of an inflammatory myofibroblastic tumour 16 have been reported. Removing organic and inorganic foreign bodies using cryotherapy has successfully been reported in a study comprising 12 children 17 and in two case reports.…”

“…In adults, a recent shift towards cryobiopsy can be observed 8 . Restoration of airway patency using cryo has been described more frequently in children 9 and for a variety of pathologies, such as plastic bronchitis 10,11 tracheal stenosis, 12,13 and the recanalization of obstructed bronchial stents 14 . Additionally, the removal of bronchial mucoepidermoid carcinoma in six patients 15 and the debulking of an inflammatory myofibroblastic tumour 16 have been reported.…”