Feasibility and long-term safety of Ho:YAG laser lithotripsy in broncholithiasis patients

Abstract

Background Treatment of broncholithiasis is complex, especially in the case of a large or transbronchial broncholith. Holmium-yttrium aluminum garnet (Ho:YAG) laser lithotripsy may be a useful treatment in broncholithiasis; however, as it is not yet common practice, the optimal parameters are unknown. Methods We performed a single-center retrospective analysis of the clinical data of 13 broncholithiasis patients who underwent Ho:YAG laser lithotripsy from May 2012 to October 2018. Results For the 13 patients (2 males and 11 females), Ho:YAG laser lithotripsy was performed 17 times, in total. All procedures were performed under general anesthesia with rigid bronchoscopy. We initially set the Ho:YAG laser to a pulse frequency of 5 Hz and a pulse energy of 0.8 J, gradually increasing these as required. The pulse frequency range we employed was 5–15 Hz, and the pulse energy range was 0.8–1.6 J. All broncholiths were successfully extracted after lithotripsy, and all symptoms improved. Hemoptysis, bronchial esophageal fistula, and pneumonia were the most common complications; however, there were no long-term complications. Conclusions Ho:YAG laser lithotripsy is an effective and safe treatment for broncholithiasis, over a long-term follow up.

Combined Endoscopic Laser and Cryotherapy Management of Pediatric Central Airway Obstruction Secondary to a Histoplasmosis-Related Broncholith

“…Large size, difficult location, or presence of significant amount of granulation tissue may also limit the use of this method. Recently, the use of Nd:YAG and holmium:neodymium-yttrium, aluminum, garnet (Ho:YAG) laser lithotripsy for large or transbronchial broncholiths has been described, both with a high treatment success rate [ 10 , 11 ]. Both laser types have good coagulation properties, which minimizes the amount of bleeding encountered.…”

“…The biggest risks in the use of laser therapy are airway damage in the form of perforation and the risk of airway fire. The fraction of inspired oxygen (FiO 2 ) and power/frequency settings should be carefully chosen [ 11 ].…”

“…We elected to use both laser therapy and cryotherapy to compensate for the disadvantages of each method and thus obtain better results. The two modalities should be considered after careful examination of chest imaging and the relationship to the surrounding vascular structure to avoid catastrophic bleeds [ 11 , 12 ].…”