Cryotherapy and Cryodebridement

Sunna, Ramez

doi:10.1007/978-1-4614-4292-9_33

Cited by 9 publications

(11 citation statements)

References 13 publications

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“…(7) Purported advantages of the biopsy technique include larger specimens with less artifact. (8, 9) However, the specific etiologies by which cryoprobes routinely improve diagnostic yield are unknown. The aim of this study is to report our experience with TBLC in the diagnosis of patients with DPLD, and to compare the yield of TBLB and TBLC when performed simultaneously in the same patient.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

Ramaswamy

Homer²,

Killam³

et al. 2016

Journal of Bronchology &Amp; Interventional Pulmonology

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Background Diffuse parenchymal lung diseases (DPLDs) are common. An accurate diagnosis is essential due to differences in etiology, cli nicopathologic features, therapeutic options and prognosis. Transbronchial lung biopsies (TBLB) are often limited by small specimen size, crush artifact and other factors. Transbronchial lung cryobiopsies (TBLC) are under investigation to overcome these limitations. Methods We conducted a retrospective study of 56 patients in a single, tertiary-care academic center in order to compare the yield of both techniques when performed in the same patient. Patients underwent flexible bronchoscopy using moderate sedation with TBLB followed by TBLC in the most radiographically abnormal areas. Clinical data and post-procedural outcomes were reviewed, with a final diagnosis made utilizing a multidisciplinary approach. Results The mean age was 60 and 53.6% were male. Co-morbidities included COPD (14%) and prior malignancy (48%). The number of TBLB specimens ranged from 1–10 per patient (mean 4) and size varied from 0.1–0.8 cm. The number of TBLC specimens ranged from 1–4 per patient (mean 2) and size ranged from 0.4–2.6 cm. Both techniques provided the same diagnosis in 26 patients (46.4%). An additional 11 (19.6%) patients had a diagnosis established by adding TBLC to TBLB. Compared to TBLB, TBLC had a higher diagnostic yield in patients with hypersensitivity pneumonitis and interstitial lung disease. Only two patients required video-assisted thoracoscopic surgery (VATS) to establish a diagnosis. Complications included pneumothorax (19.6%) and massive hemoptysis (1.8%). Conclusions TBLC used with TBLB can improve the diagnostic yield of flexible bronchoscopy in patients with DPLD.

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Section: Introductionmentioning

confidence: 99%

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

Ramaswamy

Homer²,

Killam³

et al. 2016

Journal of Bronchology &Amp; Interventional Pulmonology

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“…The success of the technique depends on the temperature needed for tissue destruction, the rate of freezing and thawing, the number of freeze/thaw cycles, the mass of tissue to destroy, and the contact area between the tissue and the probe. 8 Once a lesion that is amenable for SCT is identified, it is recommended that the probe is placed next to the lesion, under direct vision, with insufflation lasting no longer than 5 s. Cycles are usually repeated in sets of 3, 8 until the lesional tissue is judged to have been frozen. One advantage of this technique is the ability to use high FiO 2 , making it a good option for patients with respiratory distress, which is common in patients with significant airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Instability Following Airway Spray Cryotherapy

Pedoto

Desiderio

Amar

et al. 2016

Anesthesia &Amp; Analgesia

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Background Spray cryotherapy (SCT) of airway lesions is used to effectively palliate respiratory symptoms related to airway obstruction but significant intraoperative hemodynamic complications have been noted. We reviewed the experience at a single institution using SCT for the treatment of obstructive airway tumors. Methods A retrospective review of a single institution experience with intraoperative and postoperative hemodynamic complications associated with SCT was performed. Descriptive statistics were performed. Results Between June 2009 and April 2010, 34 treatment sessions were performed on 28 patients. Median age was 60 years (range, 15–88 years). Tumor characteristics were as follows: 13 primary lung cancers (43%), 11 pulmonary metastases (50%), 1 direct extension of an esophageal cancer (3%) and 2 benign pulmonary lesions (7%). Twenty-one tumors (75%) were distal to the carina; 14 (50%) were >95% occlusive. Median procedure length was 78 min (range, 15–176 min). Eleven sessions (31%) led to severe hypotension and/or bradycardia, with 2 patients requiring cardiopulmonary resuscitation. One patient died intraoperatively after cardiac arrest; a second patient was stable intra-operatively but died within 24 h of SCT. Four patients required reintubation and short-term mechanical ventilation. Conclusions Unpredictable life-threatening hemodynamic instability can follow endobronchial SCT. We propose that the most likely cause is pulmonary venous gaseous emboli entering the right heart, the coronary arteries and the systemic circulation. Although SCT may offer advantages over airway laser therapy (such as no risk of fire and rapid hemostasis), further study is needed to delineate the relative likelihood of therapeutic benefit versus catastrophic complications.

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“…Cryotherapy is the application of extreme cold energy to diseased tissue, in which cells are destroyed by the formation of intracellular ice crystals. In 1968, the first case of the use of rigid cryoprobe through a rigid bronchoscope to relieve endobronchial obstruction by a tumor causing a postobstructive pneumonia was reported 9 , 10 . Because of the need of general anesthesia and rigid bronchoscopy as well as development of other bronchoscopic treatment modalities such as laser resection, electrocautery, argon plasma coagulation, and photodynamic therapy, there was a relatively little interest in bronchoscopic cryotherapy until introduction of a flexible cryoprobe that allowed delivery through the flexible bronchoscope in 1994.…”

Section: Discussionmentioning

confidence: 99%

“…Cryogen will cool the probe tip to about -89℃. At this time, there are two techniques of cryodebridements: repeated thawing-freezing technique and pull-out technique 9 , 10 . In a repeated thawing-freezing technique, freezing is continued for 30 seconds, after which the foot pedal is released, and passive thawing is allowed.…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy

Sim

Choi

et al. 2014

Tuberc Respir Dis

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Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.

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Cryotherapy and Cryodebridement

Cited by 9 publications

References 13 publications

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

Hemodynamic Instability Following Airway Spray Cryotherapy

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy

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