Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions

Abstract

Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions

“…The major complications of cryobiopsy are bleeding and pneumothorax [ 31 ]. Prophylactic balloon occlusion and two-scope techniques have been developed to prevent severe bleeding [ 11 , 20 , 22 , 32 ]. Previous studies reported that moderate and severe bleeding occurred in 14.0–38.9% and 0–1.2% of cases, respectively, and the incidence of pneumothorax was 0.8–6.6% when cryobiopsy was performed for PPLs [ 7 , 9 , 11 , 12 ].…”

“…Prophylactic balloon occlusion and two-scope techniques have been developed to prevent severe bleeding [ 11 , 20 , 22 , 32 ]. Previous studies reported that moderate and severe bleeding occurred in 14.0–38.9% and 0–1.2% of cases, respectively, and the incidence of pneumothorax was 0.8–6.6% when cryobiopsy was performed for PPLs [ 7 , 9 , 11 , 12 ]. A high number of cryobiopsies has been reported to be unrelated to the severity of bleeding [ 33 ]; however, bleeding obstructs the visual field during bronchoscopy and reduces the approachability of the target bronchus.…”

“…Before starting the bronchoscopy, the visibility of the lesion on radiography was checked. We applied the two-scope technique when we performed the cryobiopsy [ 11 , 20 ]; one thin scope (P260F or P290; Olympus, Tokyo, Japan) was used for diagnostic biopsy, the other (therapeutic) scope (1T260 or 1TQ290; Olympus, Tokyo, Japan)—for bleeding control. Using the thin scope, the target bronchus was approached.…”

“…In addition, the cryoprobe can obtain significantly larger amounts of both DNA and RNA extracted from samples than the forceps [ 10 ]. Although several studies have supported the safety of cryobiopsy for PPLs [ 7 , 9 , 11 , 12 ], bleeding is a common complication, making repeated biopsies difficult for bronchoscopists.…”

Evaluation of deployment capability of a novel outside-the-scope, detachable catheter system for ablation of lung lesions in ex vivo human lung models

“…Other techniques such as 2-scope technique for transbronchial cryobiopsies have been employed to minimize bleeding-related complications and achieve hemostasis. 24 , 25 This involves rapidly changing the scopes with 2 operators doing the procedure. However, this still involves a time delay between changing the scopes, involves 2 operators skilled in bronchoscopy, and does not enable real-time visualization during the procedure.…”